Cisternostomy in Subarachnoid Space for Symptomatic Rathke's Cleft Cyst

At our hospital, the initial surgical treatment of Rathke's cleft cysts is simple drainage and wall biopsy by opening the cyst. If intraoperative cerebrospinal fluid leakage occurs, subarachnoid space cisternostomy is added to prevent reaccumulation of cyst contents. We aimed to determine whether the addition of cisternostomy to simple drainage decreases postoperative reaccumulation and reoperation rates. Rathke's cleft cysts initially operated on between January 2011 and December 2021, with postoperative follow-up of more than 1 year, were retrospectively reviewed. The postoperative course was compared between Group A (simple drainage) and Group B (addition of cisternostomy in the upper part of the cyst to communicate with cyst and prechiasmatic cistern, or addition of cisternostomy at the arachnoid of the dorsum sellae behind the cyst to communicate with cyst and prepontine cistern). Ninety-five patients were identified: 84 in Group A and 11 in Group B. Statistical analysis was performed between Groups A and B. The median follow-up periods were 46 (12-137) and 56 (16-115) months, respectively. The reaccumulation rate of cystic fluid during follow-up was 48.8% (n = 48) in Group A and 45.5% (n = 5) in Group B. The median times to reaccumulation were 8 (0-42) and 20 (6-46) months in Groups A and B, respectively. Among these patients, 5 (6.0%) were reoperated in Group A and 2 (18.2%) in Group B. In summary, cisternostomy performed in the subarachnoid space by perforation or partial removal of the cyst wall does not reduce postoperative reaccumulation or reoperation rates compared with simple drainage.