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. 2024 Sep 23;8(13):CASE24268.
doi: 10.3171/CASE24268. Print 2024 Sep 23.

Spontaneous regression of Rathke's cleft cysts with conservative management: patient series

Benjamin Fixman  1 , Racheal Peterson  1 , Mark Shiroishi  2 , John D Carmichael  3 , Gabriel Zada  1
Affiliations

Spontaneous regression of Rathke's cleft cysts with conservative management: patient series

Benjamin Fixman et al. J Neurosurg Case Lessons. .

Abstract

Background: Rathke's cleft cysts (RCCs) are benign fluid-filled cysts that develop in the pituitary gland because of the abnormal embryological development of Rathke's pouch. Most RCCs are small and asymptomatic; however, they can present with symptoms or documented growth, sometimes prompting surgical treatment. For smaller asymptomatic lesions, an unknown proportion demonstrates regression over time. This study describes 3 cases of spontaneous RCC regression.

Observations: Three patients with a diagnosis of RCC demonstrated an average decrease of 78% in cyst volume over a mean interval of 3.7 months. One patient experienced the resolution of chronic headaches, whereas the other 2 patients had persistent headaches and endocrinopathies at follow-up. A systematic review included 9 studies that reported results from observational cohorts of patients with RCC, totaling 619 observed patients, with 158 (25.5%) patients demonstrating spontaneous cyst regression. In the patients with cyst regression, the majority had a resolution of symptoms.

Lessons: A substantial proportion of RCC patients managed nonsurgically demonstrated spontaneous regression. There is a role for the conservative management of RCCs in patients without significant symptoms, and surveillance should continue for a minimum of 5 years to confirm cyst stability. For patients undergoing planned surgery, same-day or recent imaging is recommended to prevent operating on involuted RCCs. https://thejns.org/doi/10.3171/CASE24268.

Keywords: Rathke’s cleft cyst; case report; conservative management; pituitary cyst; spontaneous regression.

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Figures

FIG. 1.
FIG. 1.
Case 1. Brain MRI in a 31-year-old male with a cystic sellar mass (AandB) demonstrating a significant decrease in cyst volume (CandD).
FIG. 2.
FIG. 2.
Case 2. In a 23-year-old female with panhypopituitarism, MRI demonstrated a cystic sellar mass with suprasellar extension (AandB) that demonstrated spontaneous regression (CandD).
FIG. 3.
FIG. 3.
Case 3. MRI in a 29-year-old male with headaches and a cystic sellar mass (AandB) that regressed spontaneously (CandD). Cyst size remained stable 1 year later with no evidence of new growth (EandF).
See this image and copyright information in PMC

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