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¹Iran University of Medical Sciences, Hazrat Rasoul Akram Hospital, Endoscopic Pituitary and Skull Base Surgery Unit, ENT-Head and Neck Research Center and Department, Tehran, Islamic Republic of Iran
²Shaheed Beheshti University of Medical Sciences, Loghman Hakim Hospital, Department of Neurosurgery, Tehran, Islamic Republic of Iran
³Iran Mehr Hospital, Department of Neurosurgery, Tehran, Islamic Republic of Iran DOI : 10.5137/1019-5149.JTN.5991-12.1 Rathke cleft cyst (RCC) is an uncommon albeit benign sellar lesion with an incidence rate of between 2 to 33%. RCCs are usually asymptomatic except in the large cases whit suprasellar extension. We herein describe a unique case of RCC, which presented with severe visual loss owing to massive herniation of the optic chiasm and third ventricle down into the sphenoid sinus through a small 8×8 mm foramen after transnasal endoscopic surgical fenestration and marsupialization of the cyst. We describe a reconstruction method via endonasal transsphenoidal approach in this case and suggest prophylactic reconstruction of the sellar floor in sellar lesions with equal or more voluminous suprasellar extensions that are susceptible to such massive herniation and secondary empty sella syndrome. Keywords : Rathke cleft cysts, Sella turcica, Secondary empty sella syndrome