Endocrinopathy, vision, headache, and recurrence after transsphenoidal surgery for Rathke cleft cysts.
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.
Wait
Scott D
SD
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Garrett
Mark P
MP
Little
Andrew S
AS
Killory
Brendan D
BD
White
William L
WL
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