2026 Poster Presentations
P293: ENDOSCOPIC MANAGEMENT OF SYMPTOMATIC RATHKE'S CLEFT CYSTS: A SINGLE-ARM META-ANALYSIS OF RECURRENCE PATTERNS AND ENDOCRINOLOGICAL OUTCOMES
Khushal Gupta, MBBS1; Michael Karsy, MD, PhD, MSc, FAANS, FCNS2; 1Bharat Ratna Late Shri Atal Bihari Vajpayee Memorial Medical College; 2University of Michigan Health
Background: Rathke’s cleft cysts (RCCs) are benign sellar lesions that can cause disabling headaches, visual problems, and hormonal disturbances. Endoscopic transsphenoidal surgery (ETS) has become the preferred approach for symptomatic cases, yet questions remain regarding the risks of recurrence and postoperative endocrine dysfunction. We performed a meta-analysis to provide a clearer understanding of the long-term safety and effectiveness of ETS for RCCs.
Methods: Following PRISMA guidelines, PubMed, Embase, and Scopus were searched through 2025. Studies were eligible if they reported outcomes of ≥5 patients undergoing endoscopic surgery for RCC. Two reviewers independently extracted data, including clinical presentation, surgical strategy, complications, and recurrence. Random-effects meta-analysis was conducted using inverse variance weighting and the Freeman–Tukey double arcsine transformation, with pooled event rates expressed as proportions and 95% confidence intervals (CIs). Heterogeneity was quantified with χ² and I² statistics.
Results: A total of 11 studies were included. The mean or median follow-up across cohorts ranged from 12 to 96 months. Intraoperative CSF leaks were relatively frequent, occurring in about one in four patients (25%, 95% CI: 18–33%), while postoperative leaks were uncommon at 3% (95% CI: 2–5%). Headache relief was consistent, with 76% (95% CI: 60–95%) of patients experiencing meaningful improvement. New endocrinological disturbances were less common: arginine vasopressin deficiency developed in 7% (95% CI: 0–23%) and hypothyroidism in 6% (95% CI: 2–11%). Radiographic recurrence occurred in 8% (95% CI: 4–13%), while symptomatic recurrence was observed in 5% (95% CI: 2–8%). Both recurrence outcomes demonstrated moderate-to-high heterogeneity, likely reflecting differences in surgical aggressiveness and duration of imaging surveillance. Importantly, no perioperative mortality was reported, and lasting morbidity was low.
Conclusions: Endoscopic transsphenoidal surgery provides patients with symptomatic RCCs a safe and effective treatment, offering durable headache relief, low recurrence rates, and limited long-term endocrine risk. While aggressive cyst wall resection may reduce recurrence, it appears to increase the risk of new endocrine dysfunction, emphasizing the need to balance durable disease control with preservation of pituitary function. Prospective registries and standardized outcome reporting will be essential to refining surgical strategies and optimizing patient-centered care.
