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Rathke’s cleft cysts: review of natural history and surgical outcomes

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Abstract

Rathke’s cleft cysts (RCCs), also known as pars intermedia cysts, represent benign lesions formed from remnants of the embryologic Rathke’s pouch. Commonly asymptomatic, they are identified in nearly 1 in 6 healthy volunteers undergoing brain imaging. When symptomatic, they can cause headaches, endocrine dysfunction, and, rarely, visual disturbances. A systematic review of the published English literature was performed focusing on large modern case series of RCCs to describe their natural history, clinicopathologic features, radiographic features, and surgical outcomes, including rates of recurrence. The natural history of asymptomatic RCCs is one of slow growth, suggesting that observation through serial magnetic resonance imaging is appropriate for smaller asymptomatic RCCs. Symptomatic RCCs can be treated by surgical resection with low morbidity, usually through an endonasal transsphenoidal corridor using either a microscope or an endoscope. Surgical treatment frequently provides symptomatic relief of headaches and visual disturbances, and sometimes even improves endocrine dysfunction. Rates of recurrence after surgical treatment range from 16 to 18 % in large series, and higher rates of recurrence are associated with suprasellar location, inflammation and reactive squamous metaplasia in the cyst wall, superinfection of the cyst, and use of a fat graft into the cyst cavity.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of California at San Francisco (UCSF), 505, Parnassus Avenue Room M779, San Francisco, CA, 94143-0112, USA

    Seunggu J. Han, John D. Rolston, Arman Jahangiri & Manish K. Aghi

  2. Center for Minimally Invasive Skull Base Surgery (MISB), 505, Parnassus Avenue Room M779, San Francisco, CA, 94143-0112, USA

    Manish K. Aghi

  3. The California Center for Pituitary Disorders (CCPD), 505, Parnassus Avenue Room M779, San Francisco, CA, 94143-0112, USA

    Manish K. Aghi

Authors
  1. Seunggu J. Han
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  2. John D. Rolston
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  3. Arman Jahangiri
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  4. Manish K. Aghi
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Correspondence to Manish K. Aghi.

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Han, S.J., Rolston, J.D., Jahangiri, A. et al. Rathke’s cleft cysts: review of natural history and surgical outcomes. J Neurooncol 117, 197–203 (2014). https://doi.org/10.1007/s11060-013-1272-6

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  • DOI: https://doi.org/10.1007/s11060-013-1272-6

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