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Background <p>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.</p> Methods <p>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.</p> Results <p>At median follow-up of 63&#xa0;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&#xa0;years was 94.4%, 87%, and 83.3%, respectively. Multivariate analysis identified three independent predictors: preoperative visual impairment (HR 32.8, <i>p</i> = 0.003), histopathological inflammation (HR 10.6, <i>p</i> = 0.013), and T1 hyperintense signal (HR 8.5, <i>p</i> = 0.019). Most recurrences occurred within three years, suggesting incomplete suprasellar drainage as the primary mechanism.</p> Conclusions <p>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.</p>

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Surgical outcomes and predictors of recurrence following endoscopic endonasal marsupialization of Rathke’s cleft cysts

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月18日

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  • Raywat Noiphithak,
  • Supapitch Subenja,
  • Bheem Pongsukvechkul,
  • Pree Nimmannitya

摘要

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.