Management of Rathke's cleft cysts.
BACKGROUND
Incidental diagnosis of Rathke's cleft cysts (RCCs) has increased due to the improvements in imaging techniques; however, symptomatic cases are rare and accurate preoperative diagnosis can be difficult.


METHODS
Files and magnetic resonance imaging (MRI) of 10 surgically treated patients with RCC and 8 conservatively managed cases with a suspected diagnosis were reviewed retrospectively. Clinical, radiological, and histological features as well as intraoperative findings were scrutinized.


RESULTS
In the surgical group, headache was present in 4 patients, hormonal abnormality in 4, visual deficits in 3, and otolaryngological symptoms in 2. Two of the nonsurgical cases had hyperprolactinemia, and the remaining were asymptomatic. The cyst had suprasellar extension (SSE) in 9 patients and was entirely suprasellar in 1 in the surgical group. It was purely intrasellar in 6 nonsurgical cases and had SSE in 2. The cyst content showed hyperintense MRI signal in the majority of T1 and T2 images in both groups. Transsphenoidal surgery was performed in 8 and transcranial surgery in 2 patients. Squamous metaplasia and inflammation was present in 3 cases each. Initial hormonal deficiencies did not improve postoperatively and new deficits were observed in 2 cases. There was no recurrence with an average follow-up of 32 months.


CONCLUSIONS
Rathke's cleft cysts is a rare pathology with a wide spectrum of clinical and radiological features. Reactive inflammation of the normal pituitary gland may have a role in the pathogenesis of hormonal deficiency, in addition to compression. Preoperative recognition of the anteriorly displaced normal residual gland may be important in avoiding postoperative hormonal deficiency after transsphenoidal approach.
Sade
Burak
B
Division of Neurosurgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada H3T 1E2.
Albrecht
Steffen
S
Assimakopoulos
Peter
P
Vézina
Jean-Lorrain
JL
Mohr
Gérard
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D020863:Central Nervous System Cysts / Q000473:pathology* / Q000601:surgery*; D004660:Encephalitis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D005260:Female; D006261:Headache / Q000209:etiology / Q000473:pathology / Q000601:surgery; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010900:Pituitary Diseases / Q000473:pathology* / Q000601:surgery*; D010902:Pituitary Gland / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012658:Sella Turcica / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology / Q000473:pathology / Q000601:surgery