2025 Poster Presentations
P291: ENHANCING TRACT PATENCY AND PREVENTING RECURRENCE IN RECURRENT RATHKE'S CLEFT CYSTS: A NOVEL SURGICAL APPROACH USING FREE MUCOSAL GRAFTS AND BIOABSORBABLE STEROID-ELUTING STENTS WITH LONG-TERM OUTCOMES
Jonathan Tangsrivimol, MD; Nader Delavari, MD; Michael Ye, MD; Ashutosh Kacher, MD; Theodore H Schwartz, MD; Weill Cornell Medicine
Background and Objective: Recurrences can occur after surgical fenestration for symptomatic Rathke’s cleft cysts (RCCs),. This study aimed to evaluate the efficacy and safety of combining free mucosal grafts (FMGs) and bioabsorbable steroid-eluting stents following the remarsupialization of recurrent RCCs.
Methods: This study retrospectively reviewed three patients with recurrent RCCs who underwent cyst decompression followed by FMG and PROPEL steroid-eluting stent placement via an endoscopic transsphenoidal approach. The stents, embedded with mometasone furoate, are designed to dissolve over 30-45 days, reducing inflammation and scarring.
Results: The endoscopic endonasal approach with FMGs and PROPEL stents resulted in no intraoperative or postoperative complications and no cerebrospinal fluid leaks. Over an average follow-up of 35 months, no cyst recurrence was observed in two patients, while the third patient had a stable residual lesion. All patients remained asymptomatic.
Discussion: We present the first detailed description of an operative series of RCCs in which a PROPEL steroid-eluting stent and FMG were combined to delay or prevent recurrence. This combination benefits tract patency more reliably due to the localized distribution of steroids, and the FMGs further stent the cavity and promote faster healing and re-epithelization.
Conclusions: Combining FMGs and bioabsorbable steroid-eluting stents following marsupialization of recurrent RCCs is safe and effective, promoting tract patency and preventing recurrence. Longer follow-up is needed to validate these findings.