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
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.
| 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 |
| 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.
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