Endoscopic Transsphenoidal Approach for the Treatment of Pituitary Adenoma Complicated With Rathke Cleft Cyst

To summarize the clinical characteristics, key imaging diagnostic points, surgical treatment strategies, and prognosis of sellar pituitary adenoma complicated with Rathke cleft cyst (RCC). A retrospective analysis was conducted on the clinical data of 4 patients with pathologically confirmed sellar pituitary adenoma complicated with RCC who underwent endoscopic transsphenoidal surgery in the Department of Neurosurgery of the authors' hospital from January 2017 to March 2025. The data included preoperative symptoms, imaging findings, surgical methods, and follow-up results, and a comprehensive analysis was performed in combination with domestic and international literature. The 4 patients were aged 28 to 66 years, including 3 males and 1 female. The main symptoms were decreased visual acuity, headache, and acromegaly. MRI showed "cystic + solid" mixed space-occupying lesions in the sellar region: the solid part was enhanced on contrast-enhanced scans, while the cystic part was nonenhanced. All patients underwent lesion resection through the endoscopic transsphenoidal approach, with clear intraoperative separation of cystic structures and solid tumors. Pathologic confirmation was obtained postoperatively. During the 6 to 48 months of follow-up, all 4 patients achieved significant symptom relief, normalized hormone levels, no severe complications such as cerebrospinal fluid leakage or intracranial infection, and no recurrence was observed on reexamination MRI. Sellar pituitary adenoma complicated with RCC is clinically rare. Preoperative MRI showing "double-layered signal" is an important diagnostic clue. The endoscopic transsphenoidal approach is a safe and effective treatment method, and long-term postoperative follow-up of hormone levels and imaging changes is required.