Poster Presentation ESA-SRB 2023 in conjunction with ENSA

Surgical Outcomes of Marsupialisation in Rathke's Cleft Cyst Patients (#276)

Darby J Thompson 1 , Julia Low 2 3 , Nick Shoung 2 , Richard J Harvey 2 4 5 , Benjamin P Jonker 6 7 8 , Mark Winder 2 8 , Ann I McCormack 2 9 10
  1. University Of New South Wales, Sydney, NSW, Australia
  2. St. Vincent's Clinical School, University Of New South Wales, Sydney, NSW, Australia
  3. Department of Anatomical Pathology and Cytopathology, St Vincent’s Pathology, Sydney, NSW, Australia
  4. Department of Ear, Nose and Throat, St Vincent's Hospital, Sydney, NSW, Australia
  5. Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
  6. Department of Neurosurgery, Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  7. Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
  8. Department of Neurosurgery, St Vincent's Hospital, Sydney, NSW, Australia
  9. Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia
  10. Garvin Institute of Medical Research, Sydney, NSW, Australia

Objectives: To determine the outcomes of 2 different techniques for surgical management of Rathke’s cleft cysts: marsupialisation compared to fenestration.

Methods: A retrospective evaluation of all surgically resected Rathke’s Cleft Cysts from St Vincent’s Hospital, Sydney between the periods of 2015 – 2023. Clinical data including pre-operative symptoms, pituitary dysfunction and post-operative complications was collected from patient files. Radiology reports were reviewed for size, location, septation, fluid-fluid levels and intracystic nodules. Histopathological reports were reviewed to confirm diagnosis and determine any associated hypophysitis and cyst consistency.

Results: Forty-two patients were evaluated (37 marsupialisation, 5 fenestration) with 28.5% presenting with visual deficit, 59.5% with headaches and 16.7% with pituitary dysfunction. Marsupialisation led to an improvement in 75% of patients for visual symptoms and 73.9% of headaches which compares similarly to fenestration in the literature. Histologically, Rathke’s Cleft Cysts showed a higher occurrence of hypophysitis than previously reported in the literature (38.1%). Surgical complications were similar between fenestration and marsupialisation. Cyst recurrence following marsupialisation was just 2.7% compared with fenestration (10%) and notably lower than reported in the literature.

Conclusion: Marsupialisation of Rathke's Cleft Cysts lead to a significant improvement in symptom resolution with a lower cyst recurrence rate than the traditional fenestration technique. Hypophysitis appears to be a more frequently associated with Rathke’s cleft cysts that come to surgical management.