title: A Case for Conservative Management: Characterizing the Natural History of Radiographically Diagnosed Rathke Cleft Cysts.
abstract: BACKGROUND
  Rathke cleft cysts (RCCs) are benign embryonic remnants of the Rathke's pouch found in 13% to 33% of the general population. When symptomatic, they manifest themselves by compressing adjacent structures, causing pressure effects such as headache, visual disturbance, or pituitary hormone deficits. Most RCCs are asymptomatic, and their management remains controversial. Surgical resection has generally been indicated to treat symptomatic RCCs but carries the risk of complications.
  
  
  OBJECTIVE
  Our objective was to better characterize the outcomes for patients with presumed RCCs undergoing conservative management.
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  METHODS
  The setting was a pituitary program at a university medical center.
  
  
  METHODS
  The participants were 75 patients with radiographically diagnosed RCCs.
  
  
  METHODS
  All brain magnetic resonance imaging (MRI) scans performed at the University of Virginia from 2006 through 2013 were searched for the words "Rathke cleft cyst," and pituitary clinic notes from 2007 to 2012 were reviewed for patients identified as probably having an RCC. Images for all patients were reviewed by the interpreting neuroradiologist, and those patients with at least 2 MRI scans were included. The dimensions of each cyst were assessed by the same neuroradiologist, and the volume of each cyst was analyzed as a function of the time from the first image obtained.
  
  
  RESULTS
  A total of 75 patients (4-76 years old) met our inclusion criteria. The length of follow-up was 1 to 126 months (median 24 months). In 43 patients (57%) no detectable change in the size of their cysts was seen, in 21 patients (28%) cysts increased in size, and in 11 patients (15%) cysts decreased in size. The predicted mean cyst growth rate was not significantly different from 0.
  
  
  CONCLUSIONS
  The increasingly prevalent use of brain imaging modalities such as MRI has resulted in an increase in the incidental discovery of pituitary lesions. Our study demonstrates that the majority of radiologically diagnosed RCCs remain unchanged or decrease in size over time. These results suggest that, in the absence of pressure symptoms, it is reasonable to manage patients with RCCs conservatively.
authors: Department of Internal Medicine (S.A.C.), Department of Neurosurgery (Y.G., E.H.O., J.A.J.), Department of Radiology (D.A.O.), Division of Biostatistics and Epidemiology (J.T.P.), and Division of Endocrinology and Metabolism (S.A.C., M.O.T.), University of Virginia, Charlottesville, Virginia 22908.
authors: Silas A
authors: SA
authors: Culver
authors: Department of Internal Medicine (S.A.C.), Department of Neurosurgery (Y.G., E.H.O., J.A.J.), Department of Radiology (D.A.O.), Division of Biostatistics and Epidemiology (J.T.P.), and Division of Endocrinology and Metabolism (S.A.C., M.O.T.), University of Virginia, Charlottesville, Virginia 22908.
authors: Yuval
authors: Y
authors: Grober
authors: Department of Internal Medicine (S.A.C.), Department of Neurosurgery (Y.G., E.H.O., J.A.J.), Department of Radiology (D.A.O.), Division of Biostatistics and Epidemiology (J.T.P.), and Division of Endocrinology and Metabolism (S.A.C., M.O.T.), University of Virginia, Charlottesville, Virginia 22908.
authors: David A
authors: DA
authors: Ornan
authors: Department of Internal Medicine (S.A.C.), Department of Neurosurgery (Y.G., E.H.O., J.A.J.), Department of Radiology (D.A.O.), Division of Biostatistics and Epidemiology (J.T.P.), and Division of Endocrinology and Metabolism (S.A.C., M.O.T.), University of Virginia, Charlottesville, Virginia 22908.
authors: James T
authors: JT
authors: Patrie
authors: Department of Internal Medicine (S.A.C.), Department of Neurosurgery (Y.G., E.H.O., J.A.J.), Department of Radiology (D.A.O.), Division of Biostatistics and Epidemiology (J.T.P.), and Division of Endocrinology and Metabolism (S.A.C., M.O.T.), University of Virginia, Charlottesville, Virginia 22908.
authors: Edward H
authors: EH
authors: Oldfield
authors: Department of Internal Medicine (S.A.C.), Department of Neurosurgery (Y.G., E.H.O., J.A.J.), Department of Radiology (D.A.O.), Division of Biostatistics and Epidemiology (J.T.P.), and Division of Endocrinology and Metabolism (S.A.C., M.O.T.), University of Virginia, Charlottesville, Virginia 22908.
authors: John A
authors: JA
authors: Jane
authors: Department of Internal Medicine (S.A.C.), Department of Neurosurgery (Y.G., E.H.O., J.A.J.), Department of Radiology (D.A.O.), Division of Biostatistics and Epidemiology (J.T.P.), and Division of Endocrinology and Metabolism (S.A.C., M.O.T.), University of Virginia, Charlottesville, Virginia 22908.
authors: Michael O
authors: MO
authors: Thorner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020863:Central Nervous System Cysts / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000473:pathology*; D010911:Pituitary Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D057832:Watchful Waiting; D055815:Young Adult