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Menéndez-Torre EL, Gutiérrez-Hurtado A, Ollero MD, Irigaray A, Martín P, Parra P, González-Molero I, Araujo-Castro M, Idrobo C, Moure MD, Molina AR, Biagetti B, Iglesias P, Paja M, Villar-Taibo R, Pena A, Vicente A, Guerrero-Pérez F, Cordido F, Aulinas A, Mateu M, Soto A. Natural history and surgical outcomes of Rathke's cleft cysts: a Spanish multicenter study. Front Endocrinol (Lausanne) 2024; 15:1413810. [PMID: 38952395 PMCID: PMC11215184 DOI: 10.3389/fendo.2024.1413810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/04/2024] [Indexed: 07/03/2024] Open
Abstract
Rathke's cleft cysts (RCC) are a common type of lesion found in the sellar or suprasellar area. They are usually monitored clinically, but in some cases, surgery may be required. However, their natural progression is not yet well understood, and the outcomes of surgery are uncertain. The objective of this study is to evaluate the natural history of Rathke's cleft cysts in patients who are clinically monitored without treatment, and to determine the outcomes of surgery and the incidence of recurrences over time. Design and patients National multicentric study of patients diagnosed of Rathke's cleft cyst (RCC- Spain) from 2000 onwards and followed in 15 tertiary centers of Spain. A total of 177 patients diagnosed of RCC followed for 67.3 months (6-215) and 88 patients who underwent surgery, (81 patients underwent immediate surgery after diagnosis and 7 later for subsequent growth) followed for 68.8 months (3-235). Results The cyst size remained stable or decreased in 73.5% (133) of the patients. Only 44 patients (24.3%) experienced a cyst increase and 9 of them (5.1%) experienced an increase greater than 3 mm. In most of the patients who underwent surgery headaches and visual alterations improved, recurrence was observed in 8 (9.1%) after a median time of 96 months, and no predictors of recurrence were discovered. Conclusions Rathke's cleft cysts without initial compressive symptoms have a low probability of growth, so conservative management is recommended. Patients who undergo transsphenoidal surgery experience rapid clinical improvement, and recurrences are infrequent. However, they can occur after a long period of time, although no predictors of recurrence have been identified.
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Affiliation(s)
- Edelmiro Luis Menéndez-Torre
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Oviedo, Spain
- Grupo ENDO, Instituto de Investigación Biomédica del Principado de Asturias (ISPA), Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Alba Gutiérrez-Hurtado
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - María Dolores Ollero
- Department of Endocrinology and Nutrition, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ana Irigaray
- Department of Endocrinology and Nutrition, Hospital Universitario de Navarra, Pamplona, Spain
| | - Patricia Martín
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, Madrid, Spain
| | - Paola Parra
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, Madrid, Spain
| | - Inmaculada González-Molero
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA Plataforma Bionand, Málaga, Spain
| | - Marta Araujo-Castro
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Cindy Idrobo
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - María Dolores Moure
- Department of Endocrinology and Nutrition, Hospital Universitario de Cruces, Baracaldo, Spain
| | - Ana Rosa Molina
- Department of Endocrinology and Nutrition, Hospital Universitario de Cruces, Baracaldo, Spain
| | - Betina Biagetti
- Department of Endocrinology and Nutrition, Hospital Universitario Vall d’Hebrón, Barcelona, Spain
| | - Pedro Iglesias
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Miguel Paja
- Department of Endocrinology and Nutrition, Hospital Universitario de Basurto, Bilbao, Spain
| | - Rocío Villar-Taibo
- Department of Endocrinology and Nutrition, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Pena
- Department of Endocrinology and Nutrition, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Almudena Vicente
- Department of Endocrinology and Nutrition, Hospital Universitario de Toledo, Toledo, Spain
| | - Fernando Guerrero-Pérez
- Department of Endocrinology and Nutrition, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Fernando Cordido
- Department of Endocrinology and Nutrition, Hospital Universitario de Coruña, Coruña, Spain
| | - Anna Aulinas
- Department of Endocrinology and Nutrition, Hospital Sant Pau, Barcelona, Spain
| | - Manel Mateu
- Department of Endocrinology and Nutrition, Hospital Sant Pau, Barcelona, Spain
| | - Alfonso Soto
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Brandel MG, Lin C, Rennert RC, Plonsker JH, Khan UA, Crawford JR, Nation J, Levy ML. Surgical management of Rathke cleft cysts in pediatric patients: a single institution experience. Childs Nerv Syst 2024; 40:1367-1375. [PMID: 38240786 PMCID: PMC11026193 DOI: 10.1007/s00381-024-06277-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/03/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Rathke cleft cysts (RCCs) are benign, epithelial-lined sellar lesions that arise from remnants of the craniopharyngeal duct. Due to their rarity in the pediatric population, data are limited regarding the natural history and optimal management of growing or symptomatic RCCs. We present our institutional experience with the surgical management of RCCs. METHODS We performed a retrospective study of consecutive RCC patients ≤ 18 years old treated surgically at our institution between 2006 and 2022. RESULTS Overall, 567 patients with a diagnosis of pituitary mass or cyst were identified. Of these, 31 had a histopathological diagnosis of RCC, 58% female and 42% male. The mean age was 13.2 ± 4.2 years. Presenting symptoms included headache (58%), visual changes (32%), and endocrinopathies or growth delay (26%); 13% were identified incidentally and subsequently demonstrated growth on serial imaging. Six percent presented with symptomatic intralesional hemorrhage. Surgical approach was transsphenoidal for 90% of patients and orbitozygomatic for 10%. Preoperative headaches resolved in 61% of patients and preoperative visual deficits improvement in 55% after surgery. New pituitary axis deficits were seen in 9.7% of patients. Only two complications occurred from a first-time surgery: one cerebrospinal fluid leak requiring lumbar drain placement, and one case of epistaxis requiring cauterization. No patients experienced new visual or neurological deficits. Patients were followed postoperatively with serial imaging at a mean follow-up was 62.9 ± 58.4 months. Recurrence requiring reoperation occurred in 32% of patients. Five-year progression-free survival was 47.9%. Except for one patient with multiple neurological deficits from a concurrent tectal glioma, all patients had a modified Rankin Scale score of 0 or 1 (good outcome) at last follow-up. CONCLUSION Due to their secretory epithelium, pediatric RCCs may demonstrate rapid growth and can cause symptoms due to local mass effect. Surgical management of symptomatic or growing pediatric RCCs via cyst fenestration or partial resection of the cyst wall can be performed safely, with good neurologic outcomes. There is a nontrivial risk of endocrinologic injury, and long-term follow up is needed due to high recurrence rates.
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Affiliation(s)
- Michael G Brandel
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA
| | - Christine Lin
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA
| | - Robert C Rennert
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, 84112, USA
| | - Jillian H Plonsker
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA
| | - Usman A Khan
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA
| | - John R Crawford
- Division of Child Neurology and Neurosciences Institute, Children's Hospital of Orange County and University of California Irvine, Orange, CA, 92868, USA
- Division of Neurology, Rady Children's Hospital, San Diego, CA, 92123, USA
| | - Javan Nation
- Department of Otolaryngology, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA
| | - Michael L Levy
- Department of Neurosurgery, University of California, San Diego-Rady Children's Hospital, San Diego, CA, 92123, USA.
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Schmutzer-Sondergeld M, Weller J, Thorsteinsdottir J, Schichor C, Rachinger W, Thon N, Ueberschaer M. Long-term outcome of surgically treated and conservatively managed Rathke cleft cysts. Acta Neurochir (Wien) 2024; 166:159. [PMID: 38557782 PMCID: PMC10984884 DOI: 10.1007/s00701-024-06052-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Rathke cleft cysts (RCC) are benign lesions of the sellar region that require surgical treatment in case of visual deterioration or progression of the cyst. However, the natural course is often stable and asymptomatic. We aimed to investigate the characteristics of patients with cyst progression during follow-up (FU) and to compare the natural history of patients with RCC with patients who underwent surgery. METHODS Patients with an MR morphologic cystic sellar lesion classified as RCC between 04/2001 and 11/2020 were included. Functional outcomes, including ophthalmologic, endocrinologic, and MRI data, were retrospectively analyzed and compared between surgically treated patients, patients on a "watch and wait" strategy (WWS), and patients on a WWS who underwent secondary surgery due to cyst progression. RESULTS One hundred forty patients (median age 42.8 years) with RCC on MRI were identified. 52/140 (37.1%) underwent primary surgery. Of 88 patients (62.9%) with initial WWS, 21 (23.9%) underwent surgery for secondary cyst progression. Patients on the WWS had significantly smaller cyst volumes (p = 0.0001) and fewer visual disturbances (p = 0.0004), but a similar rate of hormone deficiencies (p = 0.99) compared with surgically treated patients preoperatively. Postoperatively patients suffered significantly more often from hormone deficiencies than WWS patients (p = 0.001). Patients who switched to the surgical group were significantly more likely to have preoperative T1 hyperintense signals on MRI (p = 0.0001) and visual disturbances (p = 0.001) than patients with continuous WWS. Postoperatively, these patients suffered more frequently from new hormonal deficiencies (p = 0.001). Endocrine and ophthalmologic outcomes in patients with primary and secondary surgery were comparable. Multivariate analysis showed that WWS patients were at a higher risk of requiring surgery for cyst progression when perimetric deficits (p = 0.006), hyperprolactinemia (p = 0.003), and corticotropic deficits (p = 0.005) were present. CONCLUSION Surgical treatment of RCC may cause new hormonal deficiencies, which are rare in the natural course. Therefore, the indication for surgery should be carefully evaluated. Hyperprolactinemia and corticotropic deficits were significant indicators for a secondary cyst progression in patients with RCC. However, a significant amount of almost 25% of initially conservatively managed cysts showed deterioration, necessary for surgical intervention.
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Affiliation(s)
| | - Jonathan Weller
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Jun Thorsteinsdottir
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Walter Rachinger
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistr 15, 81377, Munich, Germany
| | - Moritz Ueberschaer
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistr 15, 81377, Munich, Germany
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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Nakase K, Nishimura F, Yokoyama S, Kakutani M, Morisaki Y, Kotsugi M, Takeshima Y, Matsuda R, Young-Soo P, Nakagawa I. Long-term outcomes and potential predictive recurrence factors after endonasal endoscopic surgical treatment of symptomatic Rathke's cleft cysts. Neurosurg Rev 2024; 47:85. [PMID: 38366128 DOI: 10.1007/s10143-024-02322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
Although patients with symptomatic Rathke's cleft cysts (RCCs) receive surgical treatment, recurrence sometimes occurs after surgery. However, the mechanism underlying recurrence remains unclear. We evaluated the outcomes of RCC decompression over a long-term follow-up period. We retrospectively reviewed the medical records of 35 patients with symptomatic RCC who underwent endonasal endoscopic surgery (EES) at our institution between 2008 and 2023. Patients' characteristics, intraoperative findings, and postoperative follow-up outcomes were evaluated. A univariate regression model was used to identify the predictors of recurrence. The median patient age was 48.0 years, and 74.2% of the patients were female. The mean follow-up duration was 94.7 ± 47.6 months. Cyst content recurrence was observed in 15 patients (42.8%). Five patients (14.2%) with symptomatic recurrence underwent reoperation. Postoperative vision improved in all 23 patients (100%); headaches improved in 20 patients (90.9%). A new hormonal deficit occurred in two patients (5.7%). Complications included intraoperative cerebrospinal fluid (CSF) leak in 10 patients (28.5%), postoperative CSF leak in two patients (5.7%), permanent diabetes insipidus in two patients (5.7%), and postoperative infection in three patients (8.5%). Univariate analyses revealed that the position of the anterior pituitary lobe (p = 0.019) and preoperative visual disturbances (p = 0.008) significantly affected recurrence after surgery. Although EES was efficient, the recurrence rate was relatively high over a long-term period. The anterior pituitary lobe position and preoperative visual disturbances were significantly associated with recurrence. The anterior-inferior position can predict a high risk of recurrence before surgery.
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Affiliation(s)
- Kenta Nakase
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Fumihiko Nishimura
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan.
| | - Shohei Yokoyama
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Miho Kakutani
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Yudai Morisaki
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Yasuhiro Takeshima
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Ryosuke Matsuda
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Park Young-Soo
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
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Ding Z, Lu X, Wang Q, Qian X, Lu H, Xu R, Zhu A. Endoscopic endonasal surgery of Rathke's cleft cysts-- preoperative imaging evaluation, personalized removal and multilevel sellar floor reconstruction. Clin Neurol Neurosurg 2024; 236:108111. [PMID: 38199117 DOI: 10.1016/j.clineuro.2023.108111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES The purpose of this study was to evaluate the effectiveness of endoscopic endonasal surgery (EES) for Rathke's cleft cysts (RCCs) and the advantages of detailed preoperative imaging evaluation, intraoperative personalized removal and multilevel sellar floor reconstruction. METHODS The clinical data of 43 patients with RCCs who were treated by EES in the neurosurgery department of affiliated hospital of Jiangnan University and Wuxi No.2 People's Hospital from January 2018 to January 2023 were retrospectively analyzed. The effectiveness of EES for RCCs was analyzed by imaging information, surgical procedures, symptom improvement and complications. RESULTS All 43 RCCs were completely removed by EES, and all clinical symptoms improved to varying degrees. Postoperative relief of headache was achieved in 23 out of 26 patients (88.5 %); there was improvement in 10 out of 13 patients with visual field disorders (76.9 %) and in 8 out of 10 patients with endocrine abnormalities (80 %). New hormonal deficiency was discovered in 7 of all the patients postoperatively. There were 8 patients with postoperative diabetes insipidus and 1 patient with cerebrospinal fluid leakage. The incidence of new hormonal dysfunction and postoperative DI in expanded EES (33.3 %, 33.3 %) was higher than it in conventional EES (4 %, 8 %) (P < 0.05). The average follow-up time was 29.1 ± 14.8 months, and there were no deaths or infections. Three patients presented with cyst recurrence on MRI. CONCLUSIONS The clinical manifestations and imaging characteristics of RCCs are variable, and a detailed preoperative review of the imaging is helpful for the development of surgical plans. RCCs can be treated more safely and thoroughly with less trauma and complications by intraoperative personalized removal and multilevel sellar floor reconstruction. The high incidence of new hormonal dysfunction and postoperative DI may be related to the disturbance of the pituitary stalk. EES has unique advantages and high clinical application value for the treatment of RCCs.
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Affiliation(s)
- Zhemin Ding
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Xiaojie Lu
- Department of Neurosurgery, Jiangnan University Medical Center, Wuxi No. 2 People's Hospital, No. 68 Zhongshan Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Qing Wang
- Department of Neurosurgery, Jiangnan University Medical Center, Wuxi No. 2 People's Hospital, No. 68 Zhongshan Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Xinwei Qian
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Hua Lu
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Ran Xu
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China
| | - Aihua Zhu
- Department of Neurosurgery, The Affiliated Hospital of Jiangnan University, No. 1000 Hefeng Road, Wuxi, Jiangsu Province, China; Neuroscience Center, Wuxi School of Medicine, Jiangnan University, No. 1800 Lihu Road, Wuxi, Jiangsu Province, China.
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Khaleghi M, Vignolles-Jeong J, Otto B, Carrau R, Prevedello D. Intraoperative ultrasound-assisted endoscopic endonasal transclival marsupialization of an ectopic retrosellar Rathke's cleft cyst: A rare case illustration and systematic review of the literature. Clin Neurol Neurosurg 2024; 236:108050. [PMID: 37995620 DOI: 10.1016/j.clineuro.2023.108050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
Not every Rathke's cleft cyst (RCC) is confined within the sella between the posterior and anterior lobes of the pituitary gland. Intracranial ectopic RCCs are extremely rare, with only seven cases reported in the literature. In this study, the authors presented a rare case of a symptomatic ectopic retrosellar RCC posterior to the pituitary gland, causing extensive clival erosion. The surgical nuances of the wide marsupialization of the cyst through intraoperative ultrasound-assisted endoscopic endonasal transclival approach are described, and a systematic literature review of intracranial ectopic RCCs is conducted.
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Affiliation(s)
- Mehdi Khaleghi
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | | | - Bradley Otto
- Department of Otolaryngology-Head & Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Ricardo Carrau
- Department of Otolaryngology-Head & Neck Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Daniel Prevedello
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
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Mathios D, Joshua S, Bobeff EJ, Mistry AA, Schwartz AC, Dobri GA, Tabaee A, Kacker A, Anand VK, Schwartz TH. Durable headache relief following endoscopic endonasal resection of sub-centimeter Rathke cleft cysts in medically refractory patients. Acta Neurochir (Wien) 2023; 165:2277-2282. [PMID: 37046123 DOI: 10.1007/s00701-023-05575-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The most common presenting symptom in patients with both small and large Rathke cleft cysts (RCC) is headache (H/A). It is well established that patients with large RCC can have significant symptomatic improvement after cyst drainage. However, patients with small RCC (≤ 1 cm) are rarely operated on, even if they present with debilitating H/A. It is not well understood whether resection of these smaller RCCs can lead to durable H/A resolution. METHODS A retrospective search of our institutional database for sub-centimeter RCCs presenting with intractable H/A and treated with an endoscopic endonasal approach was carried out. A detailed H/A questionnaire as well as patient chart review was conducted to assess the long-term outcome of these patients after surgical intervention. RESULTS Ten consecutive patients with 11 endonasal surgeries met inclusion criteria. Eight responded to the questionnaire. The median cyst diameter was 6 mm (IQR 3-9). Median preoperative H/A duration was 12 months (range 2 months-15 years). H/As occurred on average for 20 days per month and all required analgesics for symptomatic control for more than 15 of these 20 days. Half of the patients also had to miss work because of H/A. Average preoperative H/A intensity was 8.7 (scale 0-10) compared with postoperative scores of 2.9 at one month, 1.6 at 3 months, and 0.9 at 1 year. There were no permanent endocrinological or other surgical complications. After a median follow-up of 2 years, one patient had radiographic and symptomatic recurrence which resolved after re-operation. CONCLUSIONS Endoscopic fenestration of sub-centimeter RCCs provides a safe and durable treatment for patients with intractable H/A.
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Affiliation(s)
- Dimitrios Mathios
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Shejoy Joshua
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
- Department of Neurosurgery, Aster Medcity, Kochi, Kerala, India
| | - Ernest J Bobeff
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
- Department of Neurosurgery, Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Adina A Mistry
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Alexandra C Schwartz
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Georgiana A Dobri
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
- Department of Endocrinology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Abtin Tabaee
- Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Ashutosh Kacker
- Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Vijay K Anand
- Department of Otolaryngology, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA.
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Seo SH, Hwang K, Ji SY, Han JH, Kim CY. Surgical Management and Long-Term Results of Rathke's Cleft Cyst. J Korean Neurosurg Soc 2023; 66:82-89. [PMID: 36274248 PMCID: PMC9837479 DOI: 10.3340/jkns.2022.0143] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/21/2022] [Accepted: 09/02/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Rathke's cleft cysts (RCCs) are nonneoplastic cysts. Most of them are asymptomatic and stable; when symptomatic, RCCs are surgically fenestrated and drained. However, the outcomes remain unclear. The authors evaluated the outcomes of RCC decompression. METHODS Between 2004 and 2019, 32 RCCs were decompressed in a single tertiary institution. The clinical characteristics, intraoperative findings, postoperative complications, and endocrinological and surgical outcomes were retrospectively reviewed. Patients who underwent sequential imaging at least twice and at least 12 months after surgery were included in the analysis. RESULTS Patients' mean age was 40.8±14.9 years, and 62.5% were women. The mean follow-up duration was 62.3±48.6 months. In 21 patients (65.6%), no residual cysts were identified on postoperative magnetic resonance imaging. Of the 18 patients with preoperative visual field defects, 17 (94.4%) experienced postoperative visual improvement. Postoperative complications included endocrinological deterioration in 11 patients (34.4%), permanent diabetes insipidus in 11 (34.4%), infection in four (12.5%), intrasellar hemorrhage in three (9.4%), and cerebrospinal fluid leak in two (6.3%). Follow-up images revealed cyst recurrence in nine patients (28.1%), an average of 20.4 months after surgery; in three patients, the cysts were symptomatic, and resection was repeated. Multivariable analysis revealed that postoperative endocrinological deterioration was the only independent factor associated with cyst recurrence (p=0.028; hazard ratio, 6.800). CONCLUSION Our findings showed that although only cyst fenestration for decompression was performed to preserve pituitary function, more pituitary dysfunction occurred than expected. Besides, the postoperative hormonal deterioration itself acted as a risk factor for cyst recurrence. In conclusion, surgery for RCC should be more careful.
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Affiliation(s)
- Seung-Ho Seo
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - So Young Ji
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Ho Han
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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Kinoshita Y, Taguchi A, Yamasaki F, Tominaga A, Arita K, Horie N. Natural course of Rathke's cleft cysts and risk factors for progression. J Neurosurg 2022; 138:1426-1432. [PMID: 36057119 DOI: 10.3171/2022.7.jns22716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/11/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rathke's cleft cysts (RCCs) are relatively common and often detected incidentally. They are usually asymptomatic and managed conservatively. However, little is known about their natural history. Thus, the authors aimed to examine the natural course of RCCs and identify the risk factors for their progression. METHODS This retrospective study examined 229 patients (median age 43.0 years) diagnosed with RCCs by MRI and followed up without surgery (median period 36.6 months). The median cyst height on the initial MRI was 10 mm. Progression or regression of RCC was defined as cyst height changes of ≥ 1 mm. RESULTS In total, 23 (10.0%) RCCs progressed, whereas 73 (31.9%) RCCs spontaneously regressed. The remaining 133 were noted to be stable throughout the follow-up period. Patients with progressed RCCs were significantly older than those with stable RCCs. In patients with acute headache as an initial symptom, RCCs were significantly more likely to spontaneously regress. New symptoms occurred in 6 patients, 5 of whom underwent surgery for RCC progression. Of these 6 patients, 1 patient had persistent adrenocorticotropic hormone deficiency and 1 patient developed diabetes insipidus. Kaplan-Meier analysis results showed RCC progression and new symptom development rates to be 12.0% and 4.1% at 5 years and 13.7% and 5.7% at 10 years, respectively. CONCLUSIONS RCCs rarely progress or cause new symptoms in the long term. Patients with asymptomatic RCC should be followed up for at least 5 years to ensure RCC inactivity. RCCs in older adults may require greater surveillance.
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Affiliation(s)
- Yasuyuki Kinoshita
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima
| | - Akira Taguchi
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima
| | - Fumiyuki Yamasaki
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima
| | - Atsushi Tominaga
- 2Department of Neurosurgery and Neuro-Endovascular Therapy, Hiroshima Prefectural Hospital, Hiroshima; and
| | - Kazunori Arita
- 3Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Nobutaka Horie
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima
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