Surgical Strategies Regarding the Extended Endoscopic Transnasal Approach for Isolated Suprasellar Rathke's Cleft Cysts.
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OBJECTIVE: This study aims to evaluate the clinical and surgical outcomes with suprasellar Rathke's cleft cysts (RCCs) treated using the extended endoscopic transnasal approach. It emphasizes surgical strategies, nuances of the technique, and the importance of cyst wall resection in optimizing outcomes while preserving postoperative pituitary function. METHODS: This retrospective study analyzed 35 patients with suprasellar RCC who underwent extended endoscopic transnasal surgery between 1997 and 2024. Data included demographics, symptoms, imaging findings, surgical details, and follow-up outcomes. The suprasellar cyst was classified as preinfundibular, retroinfundibular, and transinfundibular. Hormonal evaluations were performed, and surgical outcomes were classified as gross total resection or subtotal resection based on imaging and intraoperative findings. RESULTS: The mean age of the patients was 36.37 ± 14.23 years and female/male ratio was 29:6. Headache is the most common symptom (77.1%). Twenty patients had hormonal deficiencies in at least one hypothalamic-pituitary axis. Preinfundibular group is in 21 patients and gross total resection was achieved in 28 (80%). One patient had permanent cortisol and another thyroid deficiency. One patient had persistent postoperative diabetes insipidus. Three patients developed late postoperative syndrome of inappropriate antidiuretic hormone. CONCLUSIONS: Surgical intervention is essential for suprasellar RCCs due to their proximity to vital structures. Tailored strategies and gentle resection with minimal stalk manipulation are key to effective treatment and preserving endocrine function.