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. 2025 Jul 1;28(4):82.
doi: 10.1007/s11102-025-01554-9.

High recurrence of rathke's cleft cysts with anterior-Inferior pituitary displacement despite standard surgical approaches

Kenta Nakase  1 , Fumihiko Nishimura  2 , Yudai Morisaki  1 , Shohei Yokoyama  1 , Masashi Kotsugi  1 , Yasuhiro Takeshima  1 , Ryosuke Matsuda  1 , Shuichi Yamada  1 , Young-Soo Park  1 , Ichiro Nakagawa  1
Affiliations

High recurrence of rathke's cleft cysts with anterior-Inferior pituitary displacement despite standard surgical approaches

Kenta Nakase et al. Pituitary. .

Abstract

Purpose: Although endonasal endoscopic surgery (EES) is widely used to treat symptomatic Rathke's cleft cysts (RCCs), the optimal surgical strategy remains unclear. We previously proposed that the anatomical relationship between RCCs and the anterior pituitary lobe may predict recurrence. This study aimed to evaluate clinical characteristics and long-term outcomes based on anatomical classification and to assess the impact of surgical method (marsupialization vs. reconstruction) within each subtype.

Methods: We retrospectively analyzed 40 patients who underwent EES for symptomatic RCCs between 2008 and 2024. RCCs were classified into four types based on displacement: type 1 (anterior-superior), type 2 (anterior-inferior), type 3 (posterior-superior), and type 4 (posterior-inferior). Clinical, imaging, and surgical outcomes were compared across subtypes.

Results: he mean follow-up duration was 112 ± 53.2 months. Recurrence occurred in 16 patients (40.0%), and 6 (15.0%) patients required reoperation. Type 2 was independently associated with a higher recurrence rate (p = 0.019), more frequent preoperative visual disturbances (p = 0.0059), and lower T1-weighted signal intensity (p = 0.027). There was no significant difference in the recurrence rate between the surgical methods within each subtype.

Conclusion: The anterior-inferior subtype is more likely to recur regardless of the surgical method. The identification of high-risk subtypes may support the use of tailored strategies, including drainage-preserving techniques, to improve long-term outcomes.

Keywords: Endonasal endoscopic surgery; Long-term outcome; Marsupialization; Rathke’s cleft cysts; Reconstruction; Recurrence.

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Conflict of interest statement

Declarations. Ethical approval: Approval was obtained from the ethics committee of Nara Medical University (approval no 2652). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Consent to participate: Informed consent was obtained through an opt-out process on the university’s website. Consent to publish: Not applicable. Competing interests: The authors declare no competing interests.

References

    1. Han SJ, Rolston JD, Jahangiri A et al (2014) Rathke’s cleft cysts: review of natural history and surgical outcomes. J Neurooncol 117:197–203. https://doi.org/10.1007/s11060-013-1272-6 - DOI - PubMed
    1. Qian A, Zhou J, Zhang X et al (2022) Incidence and factors associated with the recurrence of rathke’s cleft cyst after surgery: A systematic review and meta-analysis. Front Surg 9:1065316. https://doi.org/10.3389/fsurg.2022.1065316 - DOI - PubMed
    1. Shatri J, Ahmetgjekaj I (2018) Rathke’s cleft cyst or pituitary apoplexy: A case report and literature review. Open Access Maced J Med Sci 6:544–547. https://doi.org/10.3889/oamjms.2018.115 - DOI - PubMed - PMC
    1. Aho CJ, Liu C, Zelman V et al (2005) Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg 102:189–193. https://doi.org/10.3171/jns.2005.102.2.0189 - DOI - PubMed
    1. Barkhoudarian G, Palejwala SK, Ansari S et al (2019) Rathke’s cleft cysts: a 6-year experience of surgery vs. observation with comparative volumetric analysis. Pituitary 22:362–371. https://doi.org/10.1007/s11102-019-00962-y - DOI - PubMed

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