title: Optimal surgical approaches for Rathke cleft cyst with consideration of endocrine function.
abstract: BACKGROUND
  Surgical indications for Rathke cleft cyst are not clear.
  
  
  OBJECTIVE
  To evaluate postoperative outcomes in terms of endocrine function.
  
  
  METHODS
  The study analyzed a total 73 patients who underwent transsphenoidal surgery. All patients underwent a visual field test, combined pituitary function test, and magnetic resonance imaging before and after surgery. A follow-up combined pituitary function test was performed at 1.5-year intervals.
  
  
  RESULTS
  The mean age at the time of surgery was 35 ± 14 years, and the male/female ratio was 1:1.25 (33/40). The mean follow-up duration after surgery was 59 ± 39 months. The most common symptoms were headache (84%), visual disturbance (48%), and polyuria (38%). After transsphenoidal surgery, 75% of polyuria and 96% of visual field defects were resolved, and pituitary function improved in 42% of patients. The mean age of patients who exhibited worsened hypopituitarism was significantly higher than that of patients who exhibited unchanged or improved hypopituitarism (44 ± 15.7 vs 33 ± 13.5 years; P = .02). Twelve patients (16%) experienced recollection of cyst, but none required reoperation. Five of the recollected cysts presented with characteristics that were different from those of the initial lesions, and 2 recollected cysts underwent spontaneous regression.
  
  
  CONCLUSIONS
  Minimal incision with radical removal of cyst content is reasonable to prevent the development of endocrine disturbances and other complications. Individualized risks and benefits must be assessed before a decision is reached regarding surgery and surgical method. Patients with recurrent Rathke cleft cyst require careful follow-up with special attention rather than a hasty operation.
authors.affiliation: Endocrinology, Yonsei Brain Research Institute, Seoul, Korea.
authors.forename: Jeong Kyung
authors.initials: JK
authors.lastname: Park
authors.forename: Eun Jig
authors.initials: EJ
authors.lastname: Lee
authors.forename: Sun Ho
authors.initials: SH
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020863:Central Nervous System Cysts / Q000503:physiopathology* / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007018:Hypopituitarism / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult