Clinical features of Symptomatic Rathke's cleft cyst and its surgical treatment

Abstract

Objective To explore the management of endocrine disturbance related to Symptomatic Rathke's cleft cysts (RCCs) in both pre- and post-operation, as well as the risk factors for the recurrence of RCCs after the operation. Methods The clinical manifestations, radiological and pathologic features, treatment, and surgical outcomes of 11 cases of symptomatic RCCs were reviewed retrospectively. Results Headache recovered in 100% of patients and visual disturbance improved in 83.3%, and Amenorrhea and/or galactorrhea recovered or improved in 66.7% of patients. However, diabetes insipidus and panhypopituitarism did not improve postoperatively. Transcranial surgery was performed in 6 patients and transsphenoidal surgery in 5 patients. No recurrence occurred in transcranial radical resected cases while 2 of 5 subtotally removed cases recurred with an average follow-up of 34.5 months. Inflammation was present in two of the recurrent cases. Conclusion RCCs is a rare pathology with a wide specctrum of clinical and radiological features. Accurate preoperative diagnosis can be difficult. Endocrine disturbance should be evaluated both pre- and post-operatively, and proper hormones replacement therapy is mandatory in these selected patients, Removing as much as possible and multiple biopsies around the cyst wall will be helpful in accurate diagnosis, especially of cases showing atypical pathologic findings, and special attention should be paid to follow-up examination. Key words: Rathke's cleft cysts; Microsurgery