Pituitary Function in Patients with Rathke's Cleft Cyst: Significance of Surgical Management.

Eguchi, Kuniki; Uozumi, Tohru; Arita, Kazunori; Kurisu, Kaoru; Yano, Takashi; Sumida, Masayuki; Takechi, Akihiko; Pant, Basant

doi:10.1507/endocrj.41.535

Cited by 64 publications

(100 citation statements)

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“…The low recovery rates are thought to be associated with an inflammatory process caused by the cyst contents, which may result in irreversible damage to the adjacent hypophysis. 7,8,12,25,33,43,54 Our results show that preoperative headache and visual dysfunction were resolved in 85% and 95% of patients, and both rates compare favorably with the findings of other studies. However, we achieved better resolution in the patients with hypopituitarism and DI than other series of similar sample size (55% and 65%, respectively).…”

Section: Outcome Analysissupporting

confidence: 89%

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Fan¹,

Peng²,

Qi³

et al. 2013

JNS

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R athke cleft cysts (RCCs) are regarded as benign cystic lesions derived from a remnant of the Rathke pouch. They are common findings at autopsy, with a reported incidence of 5% to 33%, and account for 6%-10% of sellar lesions. 3,9,17,32,39,46,49 Although mostly asymptomatic, some RCCs can become sufficiently large to cause compressive effect on surrounding structures, resulting in neurological and endocrine disturbances. As a result, surgical intervention is recommended for symptomatic or at-risk patients.Traditionally, the 2 most common surgical approaches are the endonasal transsphenoidal route and the standard craniotomy. The endonasal approach is typically used for sellar lesions, whereas the craniotomy is indicated for suprasellar lesions. 2,11,38,40 Owing to its reduced invasiveness Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaObject. An assessment regarding both surgical approaches and the extent of resection for Rathke cleft cysts (RCCs) based on their locations has not been reported. The aim of this study was to report the results of a large series of surgically treated patients with RCCs and to evaluate the feasibility of individualized surgical strategies for different RCCs.Methods. We retrospectively reviewed 87 cases involving patients with RCCs (16 intrasellar, 50 intra-and suprasellar, and 21 purely suprasellar lesions). Forty-nine patients were treated via a transsphenoidal (TS) approach, and 38 were treated via a transcranial (TC) approach (traditional craniotomy in 21 cases and supraorbital keyhole craniotomy in 17). The extent of resection was classified as gross-total resection (GTR) or subtotal resection (STR) of the cyst wall. Patients were thus divided into 3 groups according to the approach selected and the extent of resection: TS/STR (n = 49), TC/STR (n = 23), and TC/GTR (n = 15).Results. Preoperative headaches, visual dysfunction, hypopituitarism, and diabetes insipidus (DI) resolved in 85%, 95%, 55%, and 65% of patients, respectively. These rates did not differ significantly among the 3 groups. Overall, complications occurred in 8% of patients in TS/STR group, 9% in TC/STR group, and 47% in TC/GTR group, respectively (p = 0.002). Cerebrospinal fluid (CSF) leakage (3%), new hypopituitarism (9%), and DI (6%) were observed after surgery. All CSF leaks occurred in the endonasal group, while the TC/GTR group showed a higher rate of postoperative hypopituitarism (p = 0.7 and p < 0.001, respectively). It should be particularly noted that preoperative hypopituitarism and DI returned to normal, respectively, in 100% and 83% of patients who underwent supraorbital surgery, and with the exception of 1 patient who had transient postoperative DI, there were no complications in patients treated with supraorbital surgery. Kaplan-Meier 3-year recurrence-free rates were 84%, 87%, and 86% in the TS/STR, TC/STR, and TC/GTR groups, respectively (p = 0.9).Conclusions. It is reasonable to adopt individualized surgical strategies for RCCs based on cyst location....

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Section: Outcome Analysissupporting

confidence: 89%

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Fan¹,

Peng²,

Qi³

et al. 2013

JNS

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“…Secondly, his polyuria and polydipsia improved and he became not to need DDAVP three months after the treatment with interferon α. It is known that CDI does not tend to ameliorate even if primary disease such as inflammation [4], infiltration [5,6] or tumor [7,8], is successfully treated.…”

mentioning

confidence: 99%

Erdheim-Chester disease and pituitary involvement: a unique case and the literature

2014

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“…However, when it grows more than 1 cm or infl ammatory changes develop, various symptoms may occur [8]. Mechanical compression of the pituitary gland by the cyst, as well as infl ammation itself, may play a major role in causing pituitary dysfunction in RCC patients [8].…”

Section: Discussionmentioning

confidence: 99%

“…The reserve of the pituitary gland decreases, resulting in an empty sella fi lled with necrotic tissue in the fi nal stages [3,4]. In small number of studies, the hypopituitarism was found in 39-100% of patients with RCC [8][9][10].…”

Section: Discussionmentioning

confidence: 99%

“…Yoshida et al [11] reported that the mean age of the patients was 38 years old, and the highest frequency was in the fi fth decade with marked female preponderance. Endocrinological presentation of RCC, such as amenorrhea, is thought to be the major cause of marked female preponderance [6,8]. Mukherjee et al [1] presented the details of 12 patients with RCC.…”

Section: Discussionmentioning

confidence: 99%

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A case of Rathke's cleft cyst presenting with amenorrhea

Park

Lee

Kim

et al. 2012

Korean J Obstet Gynecol

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A 28-year-old female presented with Rathke's cleft cysts (RCC) manifesting as primary amenorrhea and no development of secondary sexual characteristics. She had no symptoms of headache, visual disturbance, anosmia or galactorrhea.. The endocrinologic study demonstrated partial hypopituitarism. Magnetic resonance imaging revealed about 1.5 cm sized sellar and suprasellar cystic tumor, extending into the pituitary stalk. Its tentative diagnosis was benign pituitary cystic tumor, such as RCC. She underwent surgery by a transsphenoidal approach. Histological examination revealed a ciliated columnar epithelium those consistent with RCC. RCC is rarely symptomatic, but mechanical compression by the cyst or infl ammation itself causes headache, visual fi eld defects, or symptoms of pituitary dysfunction. The present case shows that RCC may manifest as hypogonadotropic hypogonadism.

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Pituitary Function in Patients with Rathke's Cleft Cyst: Significance of Surgical Management.

Abstract: Abstract.The pituitary function of patients with Rathke's cleft cyst before and after surgery was investigated to clarify the significance of surgery and operative indications.The authors have treated 19

Cited by 64 publications

References 10 publications

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Erdheim-Chester disease and pituitary involvement: a unique case and the literature

A case of Rathke's cleft cyst presenting with amenorrhea

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