Successful application of stereotactic radiosurgery for multiply recurrent Rathke’s cleft cysts

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OBJECTIVE

Rathke’s cleft cysts (RCCs) are benign lesions of the sella turcica that usually come to neurosurgical attention due to compression of the optic apparatus (OA) and headaches. Treatment options for these lesions include observation, aspiration of cyst contents, or open resection of the cyst with the cyst wall. All of these options involve the potential for cyst recurrence or enlargement. In this study the authors report on a potential new therapeutic option for RCCs, i.e., stereotactic radiosurgery (SRS).

METHODS

A retrospective review was conducted of 5 patients with histologically confirmed, multiply recurrent RCCs who were treated with single-fraction SRS at a tertiary referral academic medical center.

RESULTS

The total cohort consisted of 5 female patients with an average age of 31.8 years. The most common presenting symptom was headache followed by blurry vision. The symptoms were present on average for 7 months before intervention. The median number of surgeries prior to radiosurgery was 2. The average volume of lesion treated was 0.34 cm3. The median SRS dose was 12.5 Gy prescribed to the 50% isodose line with an average prescription coverage of 96.6%. The median dose to the OA was 5 Gy. At last follow-up, 3 of 5 cysts had completely regressed, 1 had regressed by more than 50% but was still present, and 1 was stable, with an overall mean follow-up duration of 34.2 months. There were no neurological, endocrinological, or visual complications attributable to SRS during the follow-up period.

CONCLUSIONS

RCCs can be a challenging clinical entity to treat, especially when they are multiply recurrent. In patients with an average of 2 previous surgeries for resection, a single SRS session prevented recurrence universally, with an average follow-up of almost 3 years. These results indicate that further investigation of the treatment of RCCs with SRS is indicated.

ABBREVIATIONS IQR = interquartile range; OA = optic apparatus; RCC = Rathke’s cleft cyst; RION = radiation-induced optic neuritis; SRS = stereotactic radiosurgery.

Article Information

Correspondence James L. West: Wake Forest Baptist Health, Winston-Salem, NC. jlwest@wakehealth.edu.

INCLUDE WHEN CITING Published online February 1, 2019; DOI: 10.3171/2018.9.JNS181703.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 4. Images obtained in a patient treated with Gamma Knife radiosurgery with 12 Gy (red) prescribed to the 50% isodose line. Using same-day treatment planning MRI, optic structures and postoperative residual disease were contoured separately. Tumor coverage and dose was maximized to the extent that the 8-Gy isodose line (cyan) nearly abuts the OA (magenta). Figure is available in color online only.

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    Case 1. Pre-SRS coronal T2-weighted MRI (A) and T1-weighted MRI with contrast (B), as well as post-SRS coronal MRI demonstrating regression of the RCC (C and D).

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