Symptomatic Rathke’s cleft cysts: A report of 24 cases

• DOI: 10.1007/bf03347537
• Publication Date: 2014-04-04T12:37:47Z
• Authors: P. Cohan; A. Foulad; F. Esposito; N. A. Martin; D. F. Kelly
• Keywords: Endocrine recovery; Rathke's cleft cysts; Surgical outcome; Transsphenoidal surgery; Adolescent; Adult; Central Nervous System Cysts; Child; Diagnosis, Differential; Female; Headache; Humans; Hyperprolactinemia; Male; Menstruation Disturbances; Middle Aged; Recurrence; Retrospective Studies; Sexual Dysfunction, Physiological; Treatment Outcome; Endocrinology, Diabetes and Metabolism; Endocrinology; Adult; Male; Adolescent; Headache; Middle Aged; 3. Good health; Diagnosis, Differential; Hyperprolactinemia; Sexual Dysfunction, Physiological; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Recurrence; Humans; Female; Central Nervous System Cysts; Child; Menstruation Disturbances; Retrospective Studies

We review the clinical, hormonal and imaging features of 24 consecutive patients with symptomatic Rathke's cleft cysts (RCCs), and assess the long-term effectiveness and complications of transsphenoidal cyst removal. Out of 250 consecutive patients, 24 (10%) underwent endonasal transsphenoidal surgery for RCC; 19 (79%) were women. Symptoms at presentation included headaches (83%), hyperprolactinemia (38%), central hypothyroidism (21%), galactorrhea (13%), diabetes insipidus (13%), IGF-1 deficiency (13%), central adrenal insufficiency (8%) and visual loss (8%). In total, 37% of women had irregular menses and 60% of men sexual dysfunction and hypogonadism. Two girls presented with precocious puberty. Cyst size varied from 7 to 25 mm. Fifteen (60%) had a suprasellar component. Initial and 3-month post-operative imaging revealed complete cyst resection in 23 of 24 patients. Headaches resolved in 65% of subjects and visual loss resolved in both patients who presented with this symptom. Of those presenting with endocrinopathy, 56% had improvement of at least one anterior pituitary axis; two subjects (8%), both with suprasellar RCC, developed a new hormone deficiency post-operatively and two sujects young girls, (8%) had RCC recurrence, one at 36 months after surgery, requiring a second operation, and the other had a small asymptomatic recurrence 6 months after surgery. In conclusion, RCC accounts for 10 % of surgically treated sellar and suprasellar masses. Headache, hyperprolactinemia, menstrual irregularities and sexual dysfunction are common presenting symptoms. Simple cyst removal via a transsphenoidal approach offers a safe and effective treatment. Cyst recurrence may be more common in children.