Related Experiment Video
Updated: Aug 11, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Surgical outcomes and predictors of recurrence following endoscopic endonasal marsupialization of Rathke's cleft
Raywat Noiphithak1, Supapitch Subenja2, Bheem Pongsukvechkul2
1Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Thammasat University, 95 Phahonyothin Rd., Klong1, Klongluang, Pathumthani, 12120, Thailand. raywat_n@tu.ac.th.
Background:
Endoscopic endonasal marsupialization (EEM) has been widespread adopted as drainage-based techniques for treatment of Rathke's cleft cyst. However, the effectiveness of marsupialization patency and recurrence risk remains inadequately defined. This study evaluated the correlation between sustained marsupialization opening and recurrence-free survival following EEM, and identified independent predictors of recurrence.
Methods:
We performed a retrospective analysis of 54 consecutive patients with symptomatic Rathke's cleft cysts in whom endoscopic endonasal marsupialization was intended between January 2017 and December 2022. All patients received standardized fenestrated dural substitute reconstruction to maintain drainage patency. Primary outcome was radiological recurrence, with marsupialization patency assessed via serial endoscopic examination. Clinical outcomes, complications, and recurrence predictors were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards regression.
Results:
At median follow-up of 63 months, among 49 patients in whom marsupialization was achieved, patency was maintained in 45 patients (91.8%). Overall, radiological recurrence occurred in 9 of 54 patients (16.7%), with only 2 requiring reoperation. All 9 recurrences demonstrated closure of the cyst drainage, including 4 patients from succussful marsupialization, and 5 patients from intraoperative cerebrospinal fluid leak precluded marsupialization. Recurrence-free survival at 1, 2, and 3 years was 94.4%, 87%, and 83.3%, respectively. Multivariate analysis identified three independent predictors: preoperative visual impairment (HR 32.8, p = 0.003), histopathological inflammation (HR 10.6, p = 0.013), and T1 hyperintense signal (HR 8.5, p = 0.019). Most recurrences occurred within three years, suggesting incomplete suprasellar drainage as the primary mechanism.
Conclusions:
Maintenance of marsupialization patency represents the critical determinant of recurrence-free survival. Simple fenestrated dural substitute technique achieves favorable outcomes without requiring elaborate reconstruction. Visual impairment, inflammation, and T1 hyperintensity predict higher recurrence risk and warrant intensified surveillance. Future efforts should focus on preserving drainage patency when intraoperative cerebrospinal fluid leak occurs.
