Introduction: Rathke’s Cleft Cysts (RCCs) are benign lesions which usually come to neurosurgical attention due to compression of the optic apparatus and resultant headaches. Treatment options for these lesions include observation, aspiration of cyst contents, or open resection of cyst with the cyst wall. All of these options are met with the potential for cyst recurrence of enlargement. Herein we report a potential new therapeutic option: radiosurgery.
Methods: Retrospective review of 5 patients with histologically confirmed, recurrent Rathke’s Cleft Cysts who were all successfully treated with radiosurgery at a tertiary referral academic medical center.
Results: The total cohort consisted of 5 patients, all of whom were female, with an average age of 31.8 years. The most common presenting symptom was headache followed by blurry vision. The symptoms were present on average for 7 months before intervention. The median number of symptomatic recurrences treated with surgical resection was 2 prior to the use of radiosurgery. The average volume of lesion treated was 0.342cm3. The median dose was 12.5cGy with an average target volume treated of 95%. Median dose to the optic apparatus was 5cGy. No RCC recurrence or enlargement of cyst contents was observed upon follow up, with median follow up of 45 months.
Conclusions: RCCs can be a challenging clinical entity to treat, especially when they are multiply recurrent. In patients with a median of 2 previous surgeries for resection, a single radiosurgery session prevented recurrence universally, with an average follow up of almost 4 years. These exciting preliminary results indicate that further investigation of the treatment of RCC with radiosurgery is indicated.
Patient Care: This research raises the question of the potential novel role of radiosurgery in the management of Rathke's Cleft Cysts and its implications not only for recurrent cysts but for primary treatment of Rathke's Cleft Cysts with minimal mass effect.
Learning Objectives: 1) Discuss potential role of radiosurgery in the treatment of Rathke's Cleft Cysts.