The long-term recurrence of Rathke's cleft cysts as predicted by histology but not by surgical procedure

Restricted access

OBJECTIVE

Patients with symptomatic Rathke's cleft cysts (RCCs) managed by surgical treatment often experience recurrence. The authors attempted to clarify the outcome of surgically treated RCCs over a long-term follow-up period.

METHODS

Ninety-one consecutive RCC patients with a follow-up period of more than 12 months (mean 80.2 months, range 12–297 months) were retrospectively studied. The authors examined the clinical features and postoperative course of patients who experienced a reaccumulation of cyst contents visible on MRI after the initial surgery, and they investigated data from the patients who underwent reoperation for symptomatic recurrent RCCs.

RESULTS

Reaccumulation of cyst contents occurred in 36 patients (39.6%). In 34 of these patients, a reaccumulation occurred in the first 5 years after surgery. The initial cysts in these patients were most often large, with squamous metaplasia in the cyst walls. Thirteen patients (14.3%) with recurrent symptoms underwent a reoperation, and 10 of the 13 patients had a reaccumulation of RCCs within the 1st year after surgery. The reoperations were performed in the 1st year (61.5%) or several years later (23.1%). Patients were likely to initially have had a visual disturbance and the cyst walls likely included squamous metaplasia. However, no association was observed between the incidence of reaccumulation/reoperation of RCCs and the surgical procedure for RCCs.

CONCLUSIONS

The reaccumulation rate of RCC is high in the long-term period, and it is associated with the histological findings but not with the surgical procedure. Long-term monitoring, for a period of at least 5 years, should therefore be conducted to identify and assess any RCC reaccumulation.

ABBREVIATIONSRCC = Rathke's cleft cyst; TSS = transsphenoidal surgery.
Article Information

Contributor Notes

INCLUDE WHEN CITING Published online January 15, 2016; DOI: 10.3171/2015.8.JNS151282.Correspondence Yasuyuki Kinoshita, Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan. email address: y-kinoshita@hiroshima-u.ac.jp.

© Copyright 1944-2019 American Association of Neurological Surgeons

Headings
References
  • 1

    Aho CJLiu CZelman VCouldwell WTWeiss MH: Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg 102:1891932005

    • Search Google Scholar
    • Export Citation
  • 2

    Benveniste RJKing WAWalsh JLee JSNaidich TPPost KD: Surgery for Rathke cleft cysts: technical considerations and outcomes. J Neurosurg 101:5775842004

    • Search Google Scholar
    • Export Citation
  • 3

    Hama SArita KNishisaka TFukuhara TTominaga ASugiyama K: Changes in the epithelium of Rathke cleft cyst associated with inflammation. J Neurosurg 96:2092162002

    • Search Google Scholar
    • Export Citation
  • 4

    Han SJRolston JDJahangiri AAghi MK: Rathke's cleft cysts: review of natural history and surgical outcomes. J Neurooncol 117:1972032014

    • Search Google Scholar
    • Export Citation
  • 5

    Higgins DMVan Gompel JJNippoldt TBMeyer FB: Symptomatic Rathke cleft cysts: extent of resection and surgical complications. Neurosurg Focus 31:1E22011

    • Search Google Scholar
    • Export Citation
  • 6

    Jahangiri AMolinaro AMTarapore PEBlevins L JrAuguste KIGupta N: Rathke cleft cysts in pediatric patients: presentation, surgical management, and postoperative outcomes. Neurosurg Focus 31:1E32011

    • Search Google Scholar
    • Export Citation
  • 7

    Kim E: Symptomatic Rathke cleft cyst: clinical features and surgical outcomes. World Neurosurg 78:5275342012

  • 8

    Kim JEKim JHKim OLPaek SHKim DGChi JG: Surgical treatment of symptomatic Rathke cleft cysts: clinical features and results with special attention to recurrence. J Neurosurg 100:33402004

    • Search Google Scholar
    • Export Citation
  • 9

    Lillehei KOWiddel LAstete CAAWierman MEKleinschmidt-DeMasters BKKerr JM: Transsphenoidal resection of 82 Rathke cleft cysts: limited value of alcohol cauterization in reducing recurrence rates. J Neurosurg 114:3103172011

    • Search Google Scholar
    • Export Citation
  • 10

    Mendelson ZSHusain QElmoursi SSvider PFEloy JALiu JK: Rathke's cleft cyst recurrence after transsphenoidal surgery: a meta-analysis of 1151 cases. J Clin Neurosci 21:3783852014

    • Search Google Scholar
    • Export Citation
  • 11

    Potts MBJahangiri ALamborn KRBlevins LSKunwar SAghi MK: Suprasellar Rathke cleft cysts: clinical presentation and treatment outcomes. Neurosurgery 69:105810682011

    • Search Google Scholar
    • Export Citation
  • 12

    Sanno NOyama KTahara STeramoto AKato Y: A survey of pituitary incidentaloma in Japan. Eur J Endocrinol 149:1231272003

  • 13

    Teramoto AHirakawa KSanno NOsamura Y: Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology 193:1611641994

    • Search Google Scholar
    • Export Citation
  • 14

    Trifanescu RAnsorge OWass JAHGrossman ABKaravitaki N: Rathke's cleft cysts. Clin Endocrinol (Oxf) 76:1511602012

  • 15

    Trifanescu RStavrinides VPlaha PCudlip SByrne JVAnsorge O: Outcome in surgically treated Rathke's cleft cysts: long-term monitoring needed. Eur J Endocrinol 165:33372011

    • Search Google Scholar
    • Export Citation
  • 16

    Wait SDGarrett MPLittle ASKillory BDWhite WL: Endocrinopathy, vision, headache, and recurrence after transsphenoidal surgery for Rathke cleft cysts. Neurosurgery 67:8378432010

    • Search Google Scholar
    • Export Citation
  • 17

    Zada G: Rathke cleft cysts: a review of clinical and surgical management. Neurosurg Focus 31:1E12011

  • 18

    Zhong WYou CJiang SHuang SChen HLiu J: Symptomatic Rathke cleft cyst. J Clin Neurosci 19:5015082012

TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 1005 837 110
PDF Downloads 777 620 21
EPUB Downloads 0 0 0
PubMed
Google Scholar