Transsphenoidal surgical treatment of symptomatic rathke

Menendez Torre Edelmiro Luis; Hurtado Alba Gutierrez; Ollero M Dolores; Rojas Patricia Martin; Inmaculada Gonzalez-Molero; Castro Marta Araujo; Cindy Idobro; Moure Rodriguez Maria Dolores; Betina Biagetti; Pedro Iglesias; Fano Miguel Paja; Taibo Rocio Villar; Dubra Alberto Pena; Almudena Vicente; Fernando Guerrero; Fernando Cordido; Maso Ana Aulinas; Salat Manel Mateu; Alfonso Soto-Moreno

doi:10.1530/endoabs.99.P512

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Endocrine Abstracts (2024) 99 P512 | DOI: 10.1530/endoabs.99.P512

ECE2024 Poster Presentations Pituitary and Neuroendocrinology (120 abstracts)

Transsphenoidal surgical treatment of symptomatic rathke’s cysts. results, follow-up, and recurrence rates

Edelmiro Luis Menendez Torre ^1,2,3 , Alba Gutierrez Hurtado ⁴ , M Dolores Ollero ⁵ , Patricia Martin Rojas ⁶ , Inmaculada Gonzalez-Molero ⁷ , Marta Araujo Castro ⁸ , Cindy Idobro ⁸ , Maria Dolores Moure Rodriguez ⁹ , Betina Biagetti ¹⁰ , Pedro Iglesias ¹¹ , Miguel Paja Fano ^12,13 , Rocio Villar Taibo ¹⁴ , Alberto Pena Dubra ¹⁴ , Almudena Vicente ¹⁵ , Fernando Guerrero ¹⁶ , Fernando Cordido ¹⁷ , Ana Aulinas Maso ¹⁸ , Manel Mateu Salat ¹⁸ & Alfonso Soto-Moreno ¹⁹

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¹Central University Hospital of Asturias, Endocrinology and Nutrition, Oviedo, Spain; ²Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; ³University of Oviedo, Oviedo, Spain; ⁴Central University Hospital of Asturias, Oviedo, Spain; ⁵Navarra Hospital Complex - Navarra Hospital, Pamplona, Spain; ⁶La Paz University Hospital, Madrid, Spain; ⁷Hospital Regional Universitario de Málaga, Málaga, Spain; ⁸Ramón y Cajal Hospital, Madrid, Spain; ⁹Hospital Universitario de Cruces, Barakaldo, Spain; ¹⁰Vall d’Hebron University Hospital, Barcelona, Spain; ¹¹Puerta de Hierro Majadahonda University Hospital, Majadahonda, Spain; ¹²Basurto Hospital, Bilbao, Spain; ¹³Basurto University Hospital – OSI Bilbao-Basurto, Endocrinology; ¹⁴Santiago Clinic Hospital CHUS, Santiago de Compostela, Spain; ¹⁵Hospital General Universitario de Toledo, Toledo, Spain; ¹⁶Bellvitge University Hospital, L’Hospitalet de Llobregat, Spain; ¹⁷[CHUAC] University Hospital of A Coruña, A Coruña, Spain; ¹⁸Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; ¹⁹Virgen del Rocío University Hospital, Sevilla, Spain

Aim: To evaluate the efficacy of transsphenoidal surgery in patients with Rathke cleft cysts (RCCs), and recurrence rates after follow-up

Methods: A multicenter retrospective clinical practice study in patients with RCCs operated through transsphenoidal route and followed in 15 tertiary hospitals (SPAIN-QBR study) during 64.0 ± 49.0 months.

Results: A total of 85 patients with a diagnosis of RCCs underwent transsphenoidal surgery, 62 (72.9%) due to secondary clinical symptoms and 23 (27,1 %) for risk of chiasmatic compression. Most surgeries were endoscopic (74 patients) and only 11 were microscopic. Men represented 30.6% (n=26 of the cases) and 59 (69.4%) were women. The mean age was 47±19 years for men and 47±16 years for women. After surgery visual field alterations and headache improved in more than 67% of the patients but the number of patients with hormonal deficiencies increased due to new cases of arginine vasopresin deficiency (Table 1). Other complications can be seen in table 2. Total resection was achieved in 58 % of patients and after a long follow-up (64.0 ± 49.0 months) growth of cysts was seen in nine patients (10.6%) and only one required new surgery.

Table 1. Pre and post-surgery clinical alterations
	Pre-surgery	Post-surgery
Visual field defects	39 (47.1%)	12 (14.3%)	P<0,001
Neurologic alterations	5 (5.9%)	2 (2.2%)	ns
Headache	44 (4.4%)	6 (6.7%)	P<0,001
Diplopia	3 (3.5 %)	2 (2.2%)	ns
Any pituitary deficiency	41 (48.2%)	50 (58.8%)	P<0,001

Table 2. Complications of surgery
Increased anterior pituitary damage	21 (24.7 %)
Permanent arginine vasopresin deficiency	13 (15.3%)
Reinterventions	11 (12.9 %)
Cerebrospinal fluid leakage 8	(9.4%)
Meningitis	4 (4.7 %)
Intracranial hemorrhage	2 (2.4%)
Abscess	1 (1.2 %)
Mortality	1 (1.2%)

Conclusion: In patients with symptomatic Rathke cleft cysts, transsphenoidal surgery achieves an improvement in signs and symptoms due to mass-effect with low rate of complications. However, up to 11% of the cases may experience recurrence during follow-up; thus, long-term follow-up is recommended after surgery.