Professor Rathke’s gift to neurosurgery: the cyst, its diagnosis, surgical management, and outcomes

Montaser, Alaa S.; Catalino, Michael P; Laws, Edward R.

doi:10.1007/s11102-021-01155-2

Cited by 9 publications

(6 citation statements)

References 29 publications

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“…All patients in our study experienced resolution of hyperprolactinemia, probably as a result of compression of the stalk. These results are similar to those in other series of patients with RCCs, in which headaches were alleviated and vision improved in 71–96% and 70–100% of affected patients, respectively [ 1 - 4 , 7 , 12 , 15 , 21 ]. However, as in other reports, anterior pituitary function improved in only 20–46% of patients after surgery [ 1 , 3 , 21 ].…”

Section: Discussionsupporting

confidence: 90%

“…To date, no consensus has been reached about the possible predictors of RCC recurrence after surgery, including the extent of resection of the cyst wall, intraoperative alcohol instillation, sellar packing, reconstruction of the sellar floor, residual cyst shown on postoperative MRI, and inflammation and reactive squamous metaplasia revealed by histopathological examina-J Korean Neurosurg Soc 2022 Oct 24. [Epub ahead of Print] tion [1][2][3]9,12,13,15) . Of interest was that not all recurrent cysts caused symptoms serious enough to warrant reoperation.…”

Section: Discussionmentioning

confidence: 99%

“…The variation in these outcomes might be attributable to the lack of a standardized definition of recurrence and to the variation in length of follow-up [ 13 ]. To date, no consensus has been reached about the possible predictors of RCC recurrence after surgery, including the extent of resection of the cyst wall, intraoperative alcohol instillation, sellar packing, reconstruction of the sellar floor, residual cyst shown on postoperative MRI, and inflammation and reactive squamous metaplasia revealed by histopathological examination [ 1 - 3 , 9 , 12 , 13 , 15 ]. Of interest was that not all recurrent cysts caused symptoms serious enough to warrant reoperation.…”

Section: Discussionmentioning

confidence: 99%

“…Symptomatic RCCs may cause headache, nausea, visual impairment, and endocrinopathy 11) . Symptomatic RCCs are usually treated surgically, and most symptoms rehttps://doi.org/10.3340/jkns.2022.0143 solve postoperatively 15) .…”

Section: Introductionmentioning

confidence: 99%

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Surgical Management and Long-Term Results of Rathke’s Cleft Cyst

Seo

Hwang

et al. 2023

J Korean Neurosurg Soc

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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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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical Management and Long-Term Results of Rathke’s Cleft Cyst

Seo

Hwang

et al. 2023

J Korean Neurosurg Soc

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“…Whether drainage of the cyst or cyst wall resection has the best result has also been discussed. 15,31,32 In conclusion, patients with Rathke's cleft cysts are a heterogeneous group. In this study, we included smaller cysts that were not operated on.…”

Section: Petersson Et Almentioning

confidence: 92%

Natural history and surgical outcome of Rathke's cleft cysts—A study from the Swedish Pituitary Registry

Petersson

Berinder

Engström

et al. 2021

Clinical Endocrinology

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ObjectiveRathke's cleft cysts are benign, embryological remnants in the pituitary gland. The majority of them are small and asymptomatic but a few may become large, and cause mass effects, pituitary hormone deficiencies and visual impairment. Recommendations for the follow‐up of Rathke's cleft cysts vary since data on the natural history are sparse.Patients and DesignData at diagnosis and at 1, 5 and 10 years for patients with a Rathke's cleft cyst (434 at diagnosis, 317 females) were retrieved from the Swedish Pituitary Registry. Cysts ≤3 mm in diameter were excluded from the study.MeasurementsData included demographics, cyst size, pituitary function, visual defects and surgery.ResultsThe mean age at diagnosis was 45 years. In patients with cysts <10 mm in diameter (n = 204) 2.9% had pituitary hormone deficiencies and 2% had visual field impairments. Cyst size did not progress during the 5 years. Cysts with a diameter of ≥10 mm that were not operated (n = 174) decreased in size over the years (p < .01). Pituitary hormone deficiencies and visual impairments were more frequent (18% and 5.7%, respectively) but were stable over time. Transphenoidal surgery was performed in 56 patients of whom 51 underwent surgery before the 1‐year follow‐up. The mean cyst diameter at diagnosis was 18 mm (range: 9─30 mm), 36% had pituitary hormone deficiency, 45% had visual field defects and 20% had impaired visual acuity. One year after surgery 60% had no cyst remnants, 50% had a pituitary deficiency, 26% had visual field defects and 12% had impaired visual acuity. No major changes were observed after 5 years. Twelve of the operated patients had a follow‐up at 10 years, in eight the cyst remnants or recurrences increased in size over time (p < .05).ConclusionsRathke's cleft cysts with a size less than 10 mm rarely grow and our results indicate that radiological follow‐up can be restricted to 5 years. In contrast, progression of postoperative remnants or recurrent cysts is more likely and require long‐term follow‐up.

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