Steroid-Eluting Stents in the Treatment of Recurrent Rathke’s Cleft Cyst

Objectives Bioabsorbable steroid stents are placed during sinus surgery to prevent the stenosis of sinus ostia. We describe a technique to prevent the recurrence of Rathke’s cleft cysts (RCCs) after transnasal transsphenoidal surgical drainage utilizing this technology.

Study Design Retrospective chart review.

Methods Patients who underwent endoscopic surgery for recurrent RCC with placement of a bioabsorbable steroid-eluting stent were identified. Demographics, medical and surgical history, outcomes, and complications were recorded.

Results Three patients underwent marsupialization of a recurrent RCC with subsequent stent placement. All patients signed specific consent for the off-label use of the stent. The mean patient age was 34 years old, and the number of prior drainage procedures ranged from 2 to 3 ([Table 1]). In all three patients, the stent was placed directly into the opening of the cyst after drainage, utilizing the standard insertion device, with no other tissue placed into the cyst cavity or opening. For the second and third patients, the mode of deployment was modified by using a ring clamp to guide the delivery device and by placing the stent with a Blakesley forceps. The stents are bioabsorbable and were not removed after surgery but were evaluated endoscopically at 2 and 6 weeks after surgery. The patients have been currently followed up for 7 to 17 months after surgery with no evidence of recurrence on endoscopic exam or imaging. No patient had cerebrospinal fluid leak during or after the operation or permanent endocrinopathy.

Conclusion The use of a bioabsorbable steroid-eluting stent had no unanticipated consequences in three patients, and after an average of 12 months of follow-up, the drainage pathway of each RCC remain patent. The use of this technology may decrease recurrence rates in difficult recurrent cases where patients have undergone multiple failed drainage procedures and have extensive scarring of the operative field. Further study in a larger cohort is warranted.

Table 1

Patient	Age (y)	Number of prior surgeries	Years since last surgery	Prior reconstruction	Reconstruction	Number of mo of follow-up	Postoperative complications
1	<30	2	0.9	Free mucosal graft	Steroid-eluting stent	17	None
2	>50	3	4.6	None	Steroid-eluting stent	12	Diabetes insipidus, resolved without treatment
3	30–50	2	8	Nasoseptal flap	Steroid-eluting stent + nasoseptal flap to reline sphenoid	7	None

Fig. 1 Left image: second recurrence of Rathke’s cleft cyst, marked by dashed arrow, with significant scar tissue buildup marked by solid arrow. Right image: 6-month follow-up MRI with no cyst or stent remaining.

Fig. 2 (A) The recurrent Rathke’s cleft cyst is opened; note scar tissue from prior procedures. (B) The stent is placed in the cyst opening. (C) The stent is well situated and cyst opening is patent.

Fig. 3 (A) Six weeks postoperatively after stent dissolved and (B) 6 months postoperatively.