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Optimal surgical approaches for Rathke cleft cyst with consideration of endocrine function

 Kyung Park, Jeong  ;  Lee, Eun Jig  ;  Kim, Sun Ho 
 NEUROSURGERY, Vol.70(2 Suppl Operative) : 250-256, 2012 
Journal Title
Issue Date
Adolescent ; Adult ; Aged ; Central Nervous System Cysts/physiopathology* ; Central Nervous System Cysts/surgery* ; Child ; Female ; Follow-Up Studies ; Humans ; Hypopituitarism/physiopathology ; Hypopituitarism/prevention & control ; Hypopituitarism/surgery ; Male ; Middle Aged ; Retrospective Studies ; Young Adult
Diabetes insipidus ; Hypopituitarism ; Rathke cleft cyst ; Transsphenoidal surgery
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. CONCLUSION: 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.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Park, Jeong Kyung(박정경)
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
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