title: Surgical treatment of symptomatic Rathke's cleft cysts: clinical features, therapy considerations and outcomes.
abstract: BACKGROUND
  Rathke's cleft cyst (RCC) is one of the most common incidentally discovered sellar lesions, while symptomatic cases are relatively rare. Surgical treatment is recommended for symptomatic patients to drain the cyst content and to remove the capsule safely. The aim of this study was to clarify the clinical features, surgery considerations and therapy outcomes of symptomatic RCCs.
  
  
  METHODS
  Totally 42 patients (19 males and 23 females) were retrospectively reviewed with the diagnosis of RCCs under surgery resection at the Affiliated Hospital of Medical College, Qingdao University between January 2005 and December 2010.
  
  
  RESULTS
  Patients' age ranged from 6 to 67 years (mean of 41.6 years). The duration of symptoms ranged from 4 days to 10 years. Headache (69%), visual impairment (36%), and pituitary dysfunction (10%) were the most common presenting symptoms. The maximum diameter of cysts ranged from 6.0 to 46.7 mm (mean of 20.07 mm). Of the 42 patients, 36 underwent endonasal transsphenoidal approach and the others underwent transcranial approach. Thirty patients had a subtotal resection and decompression, while 12 patients had a total cyst resection. Cysts of 28 patients were lined by simple cubical or columnar epithelium, and cysts of 34 patients were filled by amorphous colloid material, that was the characteristic of RCCs. The majority of patients presented with a simple headache, and 93% of this group experienced a complete improvement after surgery. Twelve of 15 patients (80%) with preoperative visual deficits experienced an improvement in their vision after surgery. All of those patients with pituitary dysfunction experienced an improved endocrine status. The endocrinological complication usually was diabetes insipidus, and postoperative transient diabetes insipidus occurred in 13 (31%) patients without any permanent diabetes insipidus. The overall recurrence rate was 7% at a mean follow-up of 22 months (range 12 - 60 months).
  
  
  CONCLUSIONS
  Surgical treatment is to drain the contents of the cyst and to remove the capsule as much as possible under the precondition that does not increase the complications. Biopsy and decompression procedures are recommended for most cases.
authors.affiliation: Department of Neurosurgical Intensive Care Unit, Affiliated Hospital of Medical College, Qingdao University, Qingdao, Shandong 266003, China.
authors.forename: Ming-Chao
authors.initials: MC
authors.lastname: Fan
authors.forename: Qiao-Ling
authors.initials: QL
authors.lastname: Wang
authors.forename: Jing-Feng
authors.initials: JF
authors.lastname: Wang
authors.forename: Wen-Shuai
authors.initials: WS
authors.lastname: Deng
authors.forename: Lian-di
authors.initials: LD
authors.lastname: Li
authors.forename: Zhi-Hong
authors.initials: ZH
authors.lastname: Wang
authors.forename: Peng
authors.initials: P
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020863:Central Nervous System Cysts / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult