Transsphenoidal resection of 82 Rathke cleft cysts: limited value of alcohol cauterization in reducing recurrence rates
Bibliographic record
Abstract
OBJECT: The aim of this study was to report the results of a large clinical series of patients with symptomatic Rathke cleft cysts (RCCs) who underwent resection by a single neurosurgeon using intraoperative alcohol cauterization, and to review any possible differences in recurrence rates in those treated with this chemically ablative technique. METHODS: The authors performed a retrospective database review of 82 patients (age range 10-74 years) with symptomatic RCCs who underwent surgery between 1993 and 2009. RESULTS: Preoperative symptoms of headaches, vision disturbances, and hormone dysfunction were observed in 68%, 35%, and 56% of patients, respectively. All 82 patients underwent treatment by a single surgeon. Surgery consisting of simple cyst drainage followed by cyst wall biopsy without vigorous cyst wall removal was performed. A subset of these patients (62) received intraoperative alcohol instillation. Perioperative complication rates were low: CSF leakage, symptomatic hyponatremia, and permanent diabetes insipidus (DI) in 2%, 5%, and 0% of patients, respectively. Headaches and vision problems improved or resolved in 71% and 83% of patients, respectively. In addition, hyperprolactinemia, hypothyroidism, panhypopituitarism, DI, and adrenal insufficiency improved or resolved in 94%, 90%, 50%, 33%, and 67% of patients, respectively. Recurrence, as defined by enlargement of the cyst as compared with its appearance on baseline 3-month postoperative MR imaging, was noted in 10.7% of the primary surgery group. There was a trend toward increased recurrence rates in the alcohol-treated (12.9%) versus no-alcohol treatment groups (0%), although not statistically significant (p = 0.20). CONCLUSIONS: This large, single-surgeon/single-institution series of patients with symptomatic RCCs confirms that significant postoperative improvement in headaches, vision, and pituitary hormone dysfunction can be achieved via a conservative surgical approach, with low complication and recurrence rates. The data also demonstrate a limited role for alcohol cauterization in the treatment of symptomatic RCCs.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".