Table 1.
Surgical approach according to cyst location.
Fig 1.
Intraoperative images showing an intra and suprasellar Ratkhe’s Cleft Cyst removed via a standard endoscopic endonasalapproach.
(A) colloid suctioning after dural opening; (B: cyst wall removal (C) and (D) intrasellar view after the cyst wall removal. Suprasellar cistern covered by the stratified pituitary gland. Co: colloid; CW: cystwall; D: dura mater; SC: suprasellar cistern.
Fig 2.
MRI scan after gadolinium showing an intra and suprasellar Rathke’s Cleft Cyst before and after the surgical removal via a standard endoscopic endonasal approach (case showed in the Fig 1).
(A-B) Sagittal and a coronal T1-weighted scans of the lesion before being removed. The colloid has a hypointense signal and the cyst wall has post contrast enhancement. These features do not define typical aspect of RCC, whose differential diagnosis with sellar arachnoid cysts could be often challenging. (C) Axial T2-weighted scan of the lesion showing the colloid with a hyperintense signal. (D-E) Sagittal and a coronal T1-weighted scans and (F) axial T2-weightedscan at the three months postoperative MRI showing the cyst removal. It is possible to identify the decompression of the optic chiasm and the pituitary stalk.
Fig 3.
Intraoperative images showing a suprasellar Ratkhe’s Cleft Cyst removed via an extended endoscopic endonasalapproach.
(A) colloid suctioning after dural opening and exposure of the cyst’s wall (B)Imagine showing the cyst’s wall covering the neurovascular structures of the suprasellar area. (C) cyst wall removal with a forceps and aspirator. (D) after cyst wall removal it is possible to identify: A1 and A2; optic chiasm with optic nerves; pituitary stalk and gland. Co: colloid; CW: cystwall; D: dura mater; Ch: optic chiasm; Ps: pituitary stalk; Pg: pituitary gland; A1: A1 segment of the anterior cerebral artery; A2: A2 segment of the anterior cerebral artery.
Fig 4.
MRI scan showing a purely suprasellar Rathke’s Cleft Cyst before and after the surgical removal via an endoscopic endonasal approach (case showed in Fig 3).
(A-B) Sagittal and coronal T1 weighted scans showing the lesion before being removed. The colloid has an isointense signal. (C-D) Sagittal and coronal post-gad scans after three months showing the cyst removal. It is possible to identify the optic chiasm the pituitary stalk and the normal pituitary gland.
Table 2.
Preoperative clinical status according to cyst location.
Table 3.
Removal rate according to cyst location and surgical approaches.
Table 4.
Reconstruction techniques according to surgical approach.
Table 5.
Postoperative clinical status according to surgical approach.
Table 6.
Complications according to cyst location.