Introduction: Rathke’s cleft cysts (RCC) arise from the development of the Rathke’s cleft pouch. These commonly occurring cysts are typically asymptomatic, but sometimes present with headaches, endocrine dysfunction, and visual loss. Recurrence is common after either drainage or surgical removal. The purpose of this study was to review published outcomes for RCC management, and determine whether specific factors, including patient demographics, cyst pathology, radiologic parameters, or surgical techniques, predispose to their recurrence.

Methods: A systematic review of studies for RCC from 1990 to 2012 was conducted. Cases were identified using a MEDLINE/PubMED search, and from the bibliographies of relevant articles obtained from the primary search. Relevant studies reporting recurrence rate were identified, and data were extracted regarding patient demographics, presenting symptoms, cyst characteristics, surgical treatment, and outcomes. A meta-analysis for recurrence rates was also performed.

Results: Twenty-eight journal articles comprising a total of 1,151 cases of RCC revealed an average follow-up of 38 months (range, 16 to 79 months). In the studies reviewed, there was a relatively equal distribution of treatment approaches, with 35% subtotal resection (STR), 33% gross total resection (GTR), and 32% complete drainage with wall biopsy of cases. Overall recurrence rate for RCC was 12.5%. The microsurgical transsphenoidal approach was found to have a higher recurrence rate (14% versus 8%) and new endocrine dysfunction rate (25% versus 10%) compared to the endoscopic approach.

Conclusions: The data demonstrates a notable overall recurrence rate for RCC (12.5%). However, there appears to be no conclusive evidence that more aggressive resection of the cyst wall results in lower rates of recurrence.

Patient Care: Determine whether aggressive surgical removal of Rathke's cleft cysts affects recurrence rates.

Learning Objectives: 1. Perform systematic analysis of surgical cases of Rathke's cleft cysts in the literature 2. Determine overall recurrence rate of Rathke's cleft cysts after surgical removal 3. Determine what factors contribute to higher recurrence rates

References: 1. Aho CJ, Liu C, Zelman V, Couldwell WT, Weiss MH: Surgical outcomes in 118 patients with Rathke cleft cysts. J. Neurosurg. 102:189-193, 2005 2. Benveniste RJ, King WA, Walsh J, Lee JS, Naidich TP, Post KD: Surgery for Rathke cleft cysts: technical considerations and outcomes. J. Neurosurg. 101:577-584, 2004 2. Billeci D, Marton E, Tripodi M, Orvieto E, Longatti P: Symptomatic Rathke's cleft cysts: a radiological, surgical and pathological review. Pituitary 7:131-137, 2004