Treatment Of Rathke’s Cleft Cyst By Transsphenoidal Water Irrigation Under Neuroendoscope

Objective:To compare the efficacy and safety of neuroendoscopic transsphenoidal irrigation and curettage and aspiration in the treatment of Rathke’s cleft cyst.To explore the correlation between the pressure of water flushing irrigation and cerebrospinal fluid leakage after Rathke’s cleft cyst operation,and provide reference value for the clinical treatment of Rathke’s cleft cyst by neuroendoscopic water flushing irrigation.Methods:Retrospectively collected the case data of the neurosurgery of our hospital from 2012 to2021 in the treatment of Rathke’s cleft cyst with the transsphenoidal irrigation and curettage and aspiration under the neuroendoscope.A total of 32 patients were included,including 19 patients treated with neuroendoscopic transsphenoidal water flow irrigation for Rathke’s cleft cyst(water flushing group),and 19 patients treated with neuroendoscopic transsphenoidal curettage and aspiration for Rathke’s cleft cyst(curettage group)13 cases.The preoperative and postoperative clinical symptoms,pituitary function,postoperative complications,postoperative hospital stay,hospitalization costs and follow-up results between the two groups were retrospectively analyzed by t test and Fisher’s exact probability method.safety and efficacy of the method,and the safety and efficacy of the two surgical methods were evaluated.The Rathke’s cleft cyst model was constructed by simulating human brain tissue arachnoid with pig brain arachnoid,simulating the surgical steps of removing Rathke’s cleft cyst by water flow irrigation under neuroendoscopy,and controlling the water flow pressure of different gradients(1.4kpa,1.5kpa,1.6kpa,1.7kpa),1.8kpa,etc.)flushed Rathke’s cleft cyst model,recorded the relationship between water flushing pressure and cerebrospinal fluid leakage,and used t test to analyze the correlation between water flushing pressure and cerebrospinal fluid leakage.Results:In terms of the incidence of postoperative new pituitary dysfunction,the incidence of intraoperative and postoperative cerebrospinal fluid leakage,and postoperative hospital stay,the water irrigation group was lower than the curettage group,and the difference between the two groups was statistically significant(P < 0.05).There was no statistical difference between the two groups in the improvement of postoperative clinical symptoms,the recovery rate of postoperative pituitary dysfunction,the incidence of postoperative meningitis,the incidence of postoperative epistaxis,postoperative transient diabetes insipidus and recurrence(P>0.05).In the control group(arachnoid membrane group),the arachnoid membrane of the pig brain was ruptured(cerebrospinal fluid leakage)when the pressure of water flow was 1.74±0.10 k Pa.In the myxoid cyst group,the arachnoid membrane of the porcine brain was broken when the water flushing pressure was 2.02±0.16kpa;in the jelly-like cyst group,when the water flushing pressure was 5.27±0.54 kpa,the arachnoid membrane of the pig brain was broken;In the hemorrhagic cyst group,the arachnoid membrane of the porcine brain was broken when the pressure of water flow was 4.11±0.16 kpa.The jelly-like cyst group was significantly different from the control group(P=0.03),that is,the contents of the jelly-like cyst could play a buffering role to prevent the water flow from directly impacting the arachnoid.Conclusion:Both surgical procedures are safe and effective for treating Rathke’s cleft cysts.Although the most important thing in the treatment of Rathke’s cleft cyst is the cure rate and the reduction in the incidence of complications,other things being equal,there is a lower incidence of new postoperative pituitary dysfunction,and a lower incidence of intraoperative and postoperative cerebrospinal fluid leakage And a shorter postoperative hospital stay is undoubtedly a clear advantage.Rathke’s cleft cyst is treated by transsphenoidal water flow irrigation under neuroendoscopy.When the pressure of water flow reaches a certain value,the arachnoid membrane can be ruptured,resulting in cerebrospinal fluid leakage.In the treatment of Rathke’s cleft cyst with transsphenoidal water flow irrigation under neuroendoscopy,the cyst content acts as a buffer.In order to improve the clearance rate of Rathke’s cleft cyst,the pressure of water flow irrigation can be appropriately increased,but with the continuous increase of cyst content after removal,the pressure of water flushing should be decreased accordingly,otherwise it will increase the incidence of postoperative cerebrospinal fluid leakage.