title: Rathke's cleft cyst recurrence after transsphenoidal surgery: a meta-analysis of 1151 cases.
abstract: Rathke's cleft cysts (RCC) arise from the development of the Rathke's cleft pouch. These commonly occurring cysts are typically asymptomatic, but sometimes present with headaches, endocrine dysfunction, and visual loss. Recurrence is common after either drainage or surgical removal. The purpose of this study was to review published outcomes for RCC management, and determine whether specific factors, including patient demographics, cyst pathology, radiologic parameters, or surgical techniques predispose to their recurrence. A systematic review of studies for RCC from 1990 to 2012 was conducted. Patients were identified using a Medline/PubMed search, and from the bibliographies of relevant articles obtained from the primary search. Relevant studies reporting recurrence rate were identified, and data were extracted regarding patient demographics, presenting symptoms, cyst characteristics, surgical treatment, and outcomes. A meta-analysis for recurrence rates was also performed. Twenty-eight journal articles comprising a total of 1151 RCC revealed an average follow-up of 38 months (range 16-79 months). In the studies reviewed, there was a relatively equal distribution of treatment approaches, with 35% subtotal resection, 33% gross total resection, and 32% complete drainage with wall biopsy. The microsurgical transsphenoidal approach was found to have a higher recurrence rate (14% versus 8%) and new endocrine dysfunction rate (25% versus 10%) compared to the endoscopic approach. The data demonstrates a notable overall recurrence rate for RCC (12.5%). However, there appears to be no conclusive evidence that more aggressive resection of the cyst wall results in lower rates of recurrence.
authors.affiliation: Department of Neurological Surgery, Rutgers University, New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA.
authors.forename: Zachary S
authors.initials: ZS
authors.lastname: Mendelson
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
authors.forename: Qasim
authors.initials: Q
authors.lastname: Husain
authors.affiliation: Department of Neurological Surgery, Rutgers University, New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA.
authors.forename: Sedeek
authors.initials: S
authors.lastname: Elmoursi
authors.affiliation: Department of Otolaryngology, Head & Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Svider
authors.affiliation: Department of Neurological Surgery, Rutgers University, New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA; Department of Otolaryngology, Head & Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: Department of Neurological Surgery, Rutgers University, New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA; Department of Otolaryngology, Head & Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, NJ, USA. Electronic address: james.liu.md@rutgers.edu.
authors.forename: James K
authors.initials: JK
authors.lastname: Liu
mesh_terms: D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery*; D020863:Central Nervous System Cysts / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000379:methods*
keywords: Benign pituitary lesions; Endoscopic skull base surgery; Pituitary surgery; Rathke’s cleft; Rathke’s cleft cyst; Systematic review