Endocrine Morbidity and Recurrence After Transsphenoidal Surgery for Symptomatic Rathke's Cleft Cysts in South Korea:...

To evaluate outcomes of the transsphenoidal approach (TSA) for symptomatic Rathke's cleft cysts (RCCs) at a tertiary center in South Korea, focusing on recurrence, endocrine morbidity, and the selective role of extended TSA.

We reviewed 61 adults who underwent TSA for symptomatic RCCs from December 2012 to February 2024. Extended TSA was selectively used for anatomically unfavorable lesions. Outcomes included symptom improvement, radiological recurrence, reoperation for symptomatic recurrence, and persistent replacement-requiring endocrine dysfunction.

Endoscopic TSA was performed in 40 patients (66%), and extended TSA in 20 (33%). During a median follow-up of 25 months, visual improvement occurred in 54 of 56 (96%), and headache improved in 12 of 30 (40%). Radiological recurrence and reoperation for symptomatic recurrence occurred in 15 (25%) and 9 (15%), respectively. All extended TSA cases had anatomically unfavorable features. Compared with simple TSA, extended TSA was associated with lower observed radiological recurrence (5% vs 34%; log-rank p = 0.040), whereas reoperation for symptomatic recurrence was not significantly different (5% vs 20%; log-rank p = 0.196). New replacement-requiring endocrine dysfunction was more frequent after extended TSA (40% vs 15%; p = 0.049), mainly driven by diabetes insipidus/arginine vasopressin deficiency (40% vs 10%; p = 0.013).

TSA provided reliable visual improvement, while recurrence and endocrine morbidity remained clinically relevant. Extended TSA may be considered for anatomically unfavorable RCCs when adequate decompression through simple sellar fenestration is unlikely, but its low observed recurrence should be interpreted cautiously and balanced against postoperative endocrine risk.