Endoscopic endonasal marsupialization of rathke cleft cysts: clinical outcomes and risk factors analysis of visual impairment, pituitary dysfunction, and cerebrospinal fluid (CSF) leak
Authors' conclusion
Carefully considering risk factors, surgeons can appropriately counsel patients and deliver expectations for complications and long-term results. In contrast to preoperative visual impairment, preoperative pituitary dysfunction was found to have the least improvement post-surgery. It was the most significant permanent complication, with our data indicating the link to the cyst signal intensity on T2 MR and inflammation on histopathology. Earlier surgical intervention might improve the preservation of pituitary function.
Study context
- Population
- Rathke's cleft cyst (RCC) patients aged 18–80 treated by endoscopic endonasal approach and cyst marsupialization, 2010–2022; median age 34, 73% female
- Participants
- 45 patients
- Outcome
- Risk factors for preoperative visual impairment, pituitary dysfunction and intraoperative CSF leak
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
- Preoperative visual impairment and cyst diameter: OR (95% CI), p
- 1.41 (1.07 to 1.85), p-value = 0.01
- Preoperative visual impairment and older age: OR (95% CI), p
- 1.06 (1.01 to 1.11), p-value = 0.02
- Intraoperative CSF leak, cysts ≥ 2 cm: OR (95% CI), p
- 11.3 (1.25 to 97.37), p-value = 0.03
- Intraoperative CSF leak per 0.1 cm increase in cyst size: OR (95% CI), p
- 1.41 (1.08 to 1.84), p-value = 0.01
- CSF leak, T1 hypointense vs hyperintense lesions: OR (95% CI), p
- 122.88 (1.5 to 10077.54), p-value = 0.03
- Preoperative pituitary hypofunction, inflammation on histopathology: OR (95% CI), p
- 20.53 (2.20 to 191.45), p-value = 0.008
- Preoperative pituitary hypofunction, T2 hyperintensity on magnetic resonance imaging (MRI): OR (95% CI), p
- 23.2 (2.56 to 211.02), p-value = 0.005
Observational data: associations, not effects.
Further findings
Postoperative pituitary function · mean follow-up 70 ± 43 months
- Except for hyperprolactinemia, no postoperative improvement in pituitary function
Original publication
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