Diagnosis and Treatment of Symptomatic Rathke Cleft Cyst

Abstract

This article reviews the clinical manifestations, radiologic and pathologic features, treatment, and surgical outcomes of symptomatic Rathke cleft cysts (RCCs). Symptomatic RCCs have been reported to occur in patients of all ages, with a mean age ranging from 40 to 50 years, and to be more common among female patients. The common clinical presentation includes headache, visual impairment, and endocrine disturbance. The most common endocrine disturbances are hyperprolactinemia and diabetes insipidus. Most presentations improve or resolve after surgery with the exception of diabetes insipidus and panhypopituitarism, including hypothyroidism and hypocortisolism. The radiologic features on computerized tomography and magnetic resonance imaging are quite variable and may be inconclusive. The most common epithelium on pathologic examination is cuboidal or columnar epithelium, but abundant squamous metaplasia and stratified squamous epithelium are also found. Simple drainage, together with biopsy and histologic analysis of the cyst wall to exclude the possibility of neoplasm, is thought to be adequate therapy for RCC. The recurrence rates are known to be commonly low for RCC. The risk factors for recurrence of RCC are also described with a review of the literature.