ABSTRACT
Objectives: (1) Present a case of visual decompensation related to a Rathke's cleft cyst (RCC) in setting of acute COVID-19 infection. (2) Review the literature on the presentation and management of RCCs. Study Design: Case report and review of the literature. Results: We report a case of a 32-year-old female diagnosed with a sellar mass who was transferred from an outside hospital for acute visual field decompensation. Upon arrival, the patient reported a decline in vision over the past 3 days, photophobia, and diplopia with physical exam confirming these findings. Of note, patient was unvaccinated and laboratory testing revealed that she was COVID-19 positive with mild symptoms of congestion. Imaging revealed a large intrasellar and suprasellar T1 hyperintense mass with displacement of the optic chiasm superiorly ([Fig. 1]). An endoscopic transsphenoidal approach was performed and the cyst was marsupialized into the sphenoid sinus decompressing the optic chiasm. Cultures demonstrated many white blood cells, but no organisms. Pathology confirmed a diagnosis of RCC. There was no intraoperative cerebrospinal fluid leak noted. To prevent reaccumulation of cyst contents, a free mucosal graft harvested from the posterior septectomy and was used to line the sellar defect to facilitate marsupialization into the sphenoid sinus. Postoperatively, physical exam revealed normalization of her vision and extraocular movements, and the patient subjectively confirmed these findings. She was discharged home on postoperative day 3 without complications. Review of the literature demonstrates that visual field deficits are a common presenting finding in RCC patients and acute inflammation of RCCs can present similarly to pituitary apoplexy. Transsphenoidal approaches are safe and effective in surgical decompression of RCCs. Lining the exposed cyst cavity with a free mucosal graft or nasoseptal flap may facilitate promotion of an epithelialized track to prevent cyst reaccumulation. Conclusion: A case of acute visual decompensation related to a RCC in setting of acute COVID-19 infection is presented. Inflammation of the RCC, presumably related to COVID-19 infection, contributed to the acute presentation. Endoscopic transsphenoidal approaches are effective at decompression of RCCs and free mucosal grafts or nasoseptal flaps may promote epithelialization of a tract to decrease recurrences.