1
|
Ding Z, Lu X, Wang Q, Qian X, Lu H, Xu R, Zhu A. Endoscopic endonasal surgery of Rathke's cleft cysts-- preoperative imaging evaluation, personalized removal and multilevel sellar floor reconstruction. Clin Neurol Neurosurg 2024; 236:108111. [PMID: 38199117 DOI: 10.1016/j.clineuro.2023.108111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The purpose of this study was to evaluate the effectiveness of endoscopic endonasal surgery (EES) for Rathke's cleft cysts (RCCs) and the advantages of detailed preoperative imaging evaluation, intraoperative personalized removal and multilevel sellar floor reconstruction. METHODS The clinical data of 43 patients with RCCs who were treated by EES in the neurosurgery department of affiliated hospital of Jiangnan University and Wuxi No.2 People's Hospital from January 2018 to January 2023 were retrospectively analyzed. The effectiveness of EES for RCCs was analyzed by imaging information, surgical procedures, symptom improvement and complications. RESULTS All 43 RCCs were completely removed by EES, and all clinical symptoms improved to varying degrees. Postoperative relief of headache was achieved in 23 out of 26 patients (88.5 %); there was improvement in 10 out of 13 patients with visual field disorders (76.9 %) and in 8 out of 10 patients with endocrine abnormalities (80 %). New hormonal deficiency was discovered in 7 of all the patients postoperatively. There were 8 patients with postoperative diabetes insipidus and 1 patient with cerebrospinal fluid leakage. The incidence of new hormonal dysfunction and postoperative DI in expanded EES (33.3 %, 33.3 %) was higher than it in conventional EES (4 %, 8 %) (P < 0.05). The average follow-up time was 29.1 ± 14.8 months, and there were no deaths or infections. Three patients presented with cyst recurrence on MRI. CONCLUSIONS The clinical manifestations and imaging characteristics of RCCs are variable, and a detailed preoperative review of the imaging is helpful for the development of surgical plans. RCCs can be treated more safely and thoroughly with less trauma and complications by intraoperative personalized removal and multilevel sellar floor reconstruction. The high incidence of new hormonal dysfunction and postoperative DI may be related to the disturbance of the pituitary stalk. EES has unique advantages and high clinical application value for the treatment of RCCs.
Collapse
Affiliation(s)
- Zhemin Ding
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Xiaojie Lu
- Department of Neurosurgery, Jiangnan University Medical Center, Wuxi No. 2 People's Hospital, No. 68 Zhongshan Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Qing Wang
- Department of Neurosurgery, Jiangnan University Medical Center, Wuxi No. 2 People's Hospital, No. 68 Zhongshan Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Xinwei Qian
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Hua Lu
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Ran Xu
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Aihua Zhu
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China.
| |
Collapse
|
2
|
Sharifi G, Amin Darozzarbi AA, Paraandavaji E, Lotfinia M, Kazemi MA, Hajikarimloo B, Jafari A, Mohammadi E, Davoudi Z, Akbari Dilmaghani N. Vertical triband flag sign for differential diagnosis of Rathke's cleft cyst. World Neurosurg X 2024; 21:100260. [PMID: 38187505 PMCID: PMC10770743 DOI: 10.1016/j.wnsx.2023.100260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/30/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
Background The Rathke cleft cyst (RCC) is a type of cystic growth that is benign, circular, and well-defined with an incidence rate of 4 %. This study aims to identify a useful diagnostic imaging sign that can aid in the differentiation of RCC from other cystic lesions. Methods We retrospectively analyzed the records of 42 symptomatic RCC patients who were referred to our facility between 2016 and 2023. The data for the study were obtained from our electronic database. All magnetic resonance imaging (MRI) studies were performed using a 1.5-T superconducting magnetic scanner. All patients underwent endonasal transsphenoidal surgical resection. All MRIs were reviewed and evaluated by a neurosurgeon and a neuroradiologist. Results There were 8 (19 %) males and 34 (81 %) females with a mean age of 37.2-years. Our study identified a distinct imaging characteristic in 38 of the cases, which we have named the "vertical triband flag sign", due to the growth of the cyst developing a specific appearance. The flag sign was mostly observed only in the T1-images (71.5 %), while in four cases the sign was spotted only in T2-images, and in four cases it appeared in both T1 and T2. In 4 cases, the flag sign was not observed in which further investigations revealed that these cases were suprasellar or small sellar RCCs. The dot sign, which is a characteristic finding in RCCs was only observed in one of our cases. Conclusion Early diagnosis of RCCs may be facilitated by utilizing the vertical triband flag sign.
Collapse
Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arsalan Amin Darozzarbi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Paraandavaji
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmoud Lotfinia
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Medical Center Saarbruecken, Saarland, Germany
| | - Mohammad Ali Kazemi
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Bardia Hajikarimloo
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Jafari
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma, USA
| | - Zahra Davoudi
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Endocrinology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Akbari Dilmaghani
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Otolaryngology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|