BACKGROUND In patients with symptomatic Rathke's cleft cyst, transsphenoidal surgery is highly effective at preventing further visual loss and usually allows for some recovery of vision. However, cyst recurrence and the need for re-operation are well recognized. To this end, the aim of this study was to investigate patterns of recurrence and long-term outcomes and to use this information to develop an optimal follow-up strategy. METHOD A prospectively maintained database was searched over a 10-year period between 1 January 2008 and the 1 January 2018 to identify all adults that underwent transsphenoidal surgery with a new diagnosis of Rathke's cleft cyst. A retrospective case note review was performed for each patient to extract data on their presentation, investigation, treatment, and outcome. RESULTS In all, 61 eligible patients were identified. The median follow-up was 34 months (range 2-112 months). In the 22 patients with pre-operative visual loss, the outcomes at 6 months were as follows: normal vision (2/22; 9.1%), improved but not normal (7/22; 31.8%), stable (12/22; 54.5%), worse but not blind (1/22; 4.5%), and blind (0/22; 0%). The overall rate of regrowth and re-operation in our study was 19.7 and 11.5%, respectively. The only factor that was significantly associated with recurrence was the presence of residual cystic disease on the post-operative MRI (p < 0.001). CONCLUSIONS We propose a follow-up strategy that stratifies patients at "low risk" if there is no residual cyst, with increasing interval scans, or "high risk" if there is residual cyst, with annual visual assessment and scans.

中文翻译：

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经蝶手术后的拉特克裂囊肿：长期结果和最佳随访策略的制定。


背景 对于有症状的拉特克裂囊肿患者，经蝶手术对于防止进一步视力丧失非常有效，并且通常可以使视力得到一定程度的恢复。然而，囊肿复发和再次手术的需要已得到广泛认可。为此，本研究的目的是调查复发模式和长期结果，并利用这些信息制定最佳的随访策略。方法 对 2008 年 1 月 1 日至 2018 年 1 月 1 日期间的 10 年期间的前瞻性维护数据库进行检索，以确定所有接受经蝶手术且新诊断为 Rathke 裂囊肿的成人。对每位患者进行回顾性病例记录审查，以提取有关其表现、调查、治疗和结果的数据。结果 总共确定了 61 名符合条件的患者。中位随访时间为 34 个月（范围 2-112 个月）。 22例术前视力丧失的患者，6个月时的结果如下：视力正常（2/22；9.1%）、改善但不正常（7/22；31.8%）、稳定（12/22；31.8%）、稳定（12/22；31.8%）。 54.5%），更差但不失明（1/22；4.5%），以及失明（0/22；0%）。我们研究中的总体再生率和再手术率分别为 19.7% 和 11.5%。与复发显着相关的唯一因素是术后 MRI 上残留囊性病变的存在 (p < 0.001)。结论 我们提出了一种随访策略，如果没有残留囊肿，则将患者分为“低风险”，并增加间隔扫描；如果有残留囊肿，则将患者分为“高风险”，每年进行视觉评估和扫描。