title: Endocrinopathy, vision, headache, and recurrence after transsphenoidal surgery for Rathke cleft cysts.
abstract: BACKGROUND
  Rathke cleft cyst can enlarge and become symptomatic.
  
  
  OBJECTIVE
  To review the clinical data and results of all patients treated by the senior author for a Rathke cleft cyst.
  
  
  METHODS
  A prospectively maintained surgical database, supplemented with updates from telephone conversations, of all patients presenting to the Barrow Neurological Institute from 1992 to the present was reviewed.
  
  
  RESULTS
  Seventy-three patients (17 males, 56 females; mean age, 40 years; range, 5-80 years) underwent 77 resections. The mean length of follow-up was 27 months (range, 0-129 months). Presenting symptoms included headache (75%), followed by endocrinopathy (49%), and visual symptoms (39%). Preoperative chiasmopathy resolved in 75% and improved in 21% of the patients. Patients' preoperative endocrinopathy resolved at various rates, depending on the specific axis (29%-100%). Endocrinopathies were more likely to resolve in females than males. New postoperative endocrinopathies also occurred (0-8%). Headache resolved (68%) or improved (21%) in most patients. No patient had worsened headaches. Eight patients had a recurrence, 4 of whom underwent reoperation. The presence of squamous metaplasia was the only predictor of recurrence.
  
  
  CONCLUSIONS
  Surgical fenestration and/or resection of Rathke cleft cyst via the transsphenoidal approach are a rational choice for surgical management of these lesions when symptomatic. In most cases, visual symptoms and headache can be expected to improve. New persistent endocrine deficits can be expected in a small percentage of patients, but preexisting endocrinopathies resolve in many patients.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Wait
authors.forename: Mark P
authors.initials: MP
authors.lastname: Garrett
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Little
authors.forename: Brendan D
authors.initials: BD
authors.lastname: Killory
authors.forename: William L
authors.initials: WL
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020863:Central Nervous System Cysts / Q000150:complications / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004700:Endocrine System Diseases / Q000209:etiology / Q000601:surgery*; D005260:Female; D006261:Headache / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010902:Pituitary Gland / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D014786:Vision Disorders / Q000209:etiology / Q000601:surgery*; D055815:Young Adult