Objective The video stars orbitozygomatic resection of
Rathke's cleft cyst with suprasellar extension in a 37-year-old male patient presenting with severe
headaches and
bitemporal hemianopia. Clinical and radiological characteristics along with surgical technique (positioning, bony opening, surgical dissection and debulking, closure), histopathology, and postoperative course are described. Methods Preoperative MRI demonstrated a noncontrast-enhancing cystic lesion in the sella with suprasellar extension causing compression of both optic nerves. A one-piece orbitozygomatic
craniotomy was performed. The
tumor was encountered in the interoptic space. First, the
cyst was decompressed and fluid appearing like motor oil was aspirated. Both optic nerves were decompressed and dissected free from the
cyst wall. Intraoperatively, the most challenging aspect was separating the
tumor from surrounding vascular structures, including bilateral A1 arteries and the left carotid bifurcation. A combination of sharp and blunt dissection was utilized to free the
tumor from adhesions to critical neurovascular structures. Once freed, the suprasellar aspect of the
tumor was mobilized into the operative cavity and debulked. Finally, the sellar component of the
tumor was removed all the way down to the sellar floor. Postoperative MRI demonstrated decompressed bilateral optic nerves with an intact pituitary stalk with preservation of normal pituitary gland. Histopathology identified pathognomonic features consistent with diagnosis of
Rathke's cleft cyst, including flattened ciliated epithelium and presence of Rathke's cleft remnants. Results Postoperatively, bilateral improvement in vision was noted with transient
diabetes insipidus. Patient was discharged home on postoperative day 4. Conclusion A one-piece orbitozygomatic
craniotomy is an effective and safe strategy for resection of
Rathke's cleft cysts with suprasellar extension. The link to the video can be found at: https://youtu.be/-Yqtcd2gLSs .