Introduction: Rathke’s Cleft Cysts (RCCs) are benign parasellar cystic lesions. Although often incidentally found, RCCs may present with neurologic deficits including visual deficits such as bitemporal hemianopsia or diminished acuity. Compression of the adjacent pituitary gland may cause a variety of endocrinopathies. Although benign in nature, RCCs may recur. Our understanding of RCC recurrence is limited.
Methods: 113 consecutive patients surgically treated for RCCs at the University of Southern California’s Pituitary Tumor and Neuroendocrine Center between 1995-2015 were evaluated. Electronic chart reviews were conducted and patients were followed with annual ophthalmological perimetry tests, magnetic resonance imaging, and clinical examinations. Chi-square tests were used to evaluate statistical significance.
Results: 113 patients were included in the analysis with a mean follow-up time of 71 months. Ages ranged from 12-82 years (mean 46.7 years). Cyst size ranged from 4-30 mm (mean 14.7 mm). 81.4% of patients had never been operated. Presenting symptoms included headache (60% of patients), visual deficits (38%) and endocrinopathies (61%). 94% of patients with headaches, 95% of patients with visual loss, and 100% of patients with hyperprolactinemia had postoperative improvement. Patients with panhypopituitarism, hypogonadism and hypocortisolemia rarely improved.
There were no preoperative deaths or new neurologic deficits in our series. 2% of patients had postoperative CSF leaks requiring intervention and 2% of patients developed permanent diabetes insipidus.
26.4% of patients demonstrated recurrence, with mean time to recurrence of 32 months (range 12- 130 months). Predictors of recurrence included patient age (p=0.014). Squamous metaplasia (SM) was more common in patients requiring re-operation (p=0.007).
Conclusions: Surgical fenestration of RCCs is a safe treatment option with low risk of CSF leak and permanent postoperative neurologic deficits. Fenestration may relieve headaches, visual deficits and hyperprolactinemia. Older patients and patients with SM are more likely to report recurrence. Little is known about recurrent RCCs, warranting future study.
Patient Care: We describe the risks and benefits of surgery for RCC, which may improve surgical decision making for these benign lesions. Our research may help clinicians identify patients at risk for recurrent RCC.
Learning Objectives: Surgical Management of RCC
Risks of Surgery for RCC
Benefits of Surgery for RCC
Factors influencing recurrence of RCC