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. 2023 Jan;66(1):82-89.
doi: 10.3340/jkns.2022.0143. Epub 2022 Oct 24.

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

Seung-Ho Seo  1 , Kihwan Hwang  1   2 , So Young Ji  1 , Jung Ho Han  1   2 , Chae-Yong Kim  1   2
Affiliations

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

Seung-Ho Seo et al. J Korean Neurosurg Soc. 2023 Jan.

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.

Keywords: Complications; Rathke’s cleft cyst; Recurrence; Treatment outcome.

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Conflict of interest statement

Conflicts of interest

Jung Ho Han and Chae-Yong Kim have been editorial board of JKNS since May 2017. They were not involved in the review process of this original article. No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Flow diagram of patient selection. RCC : Rathke’s cleft cyst, SNUBH : Seoul National University Bundang Hospital, R/O : rule out.
Fig. 2.
Fig. 2.
Kaplan-Meier curve for recurrence free survival.
See this image and copyright information in PMC

References

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