Rathke's cleft cysts (RCC) are benign lesions that originate from remnants of Rathke'
s pouch. They can compress adjacent structures causing visual loss and endocrine dysfunction. The endoscopic endonasal transsphenoidal approach (EETA) has gained popularity in the surgical management of pituitary and parasellar
tumors. However, postoperative
cyst recurrence and endocrine dysfunction are still major concerns. A retrospective chart review was performed on 11 patients who underwent a purely EETA. Subtotal resection of the
cyst wall with drainage of the intracystic contents followed by obliteration of the
cyst with a fat graft was performed in all patients. Two patients underwent repeated surgeries for symptomatic
cyst recurrence. One patient ultimately underwent extracapsular removal of the entire
cyst wall because of multiple recurrences after simple drainage. There were no incidences of new permanent
hypopituitarism, visual deficits, or postoperative
cerebrospinal fluid leaks. All patients reported an improvement of initial preoperative symptoms. A non-aggressive strategy of partial
cyst wall removal and simple drainage of
cyst contents via EETA is a viable approach for surgical treatment of RCC with a low rate of postoperative endocrine and visual complications. A more aggressive strategy of extracapsular removal of the
cyst wall may be indicated in patients with repeated recurrence.