Surgical treatment of symptomatic Rathke cleft cysts: clinical features and results with special attention to recurrence

Restricted access

Object. Rathke cleft cysts (RCCs) are rarely symptomatic. The purpose of this study was to clarify the clinical, neuroimaging, surgical, and pathological features of symptomatic RCCs with special attention to their recurrence.

Methods. This retrospective study involved 53 patients with pathologically confirmed symptomatic RCCs. There were 28 female and 25 male patients, ranging in age from 11 to 68 years (mean 37 years). Common clinical presentations included headache, visual impairment, and endocrine disturbance. The most common endocrine disturbances were hyperprolactinemia and diabetes insipidus. Most of these improved or were resolved after surgery, with the exception of diabetes insipidus and panhypopituitarism. The cysts were intrasellar with suprasellar extension in 33 patients, and ranged in size from 5 to 40 mm (mean 17 mm). In the 50 magnetic resonance (MR) images that were reviewed, the signal intensities were quite variable. Fourteen MR images demonstrated enhancement after an injection of Gd. Intraoperatively, the cyst contents were found to be yellowish (18 patients [37%]) and mucoid (25 patients [51%]). Pathological examinations revealed a pseudostratified columnar epithelium in 26 patients (49%). Abundant squamous metaplasia and a stratified squamous epithelium were also found in 12 patients (23%). Follow-up MR images revealed cyst recurrences that required a repeated operation in six patients. Statistically significant risk factors for a recurrence included enhancement of the lesion on MR images (p = 0.017), the extent of cyst removal (p = 0.012), and the presence of squamous epithelium (p = 0.008).

Conclusions. Rathke cleft cysts are associated with a variety of clinical presentations and sometimes confusing intraoperative and pathological findings. Close postoperative observation with neuroimaging and neuroophthalmological assessment is necessary, especially after a partial removal, as in cases with squamous metaplasia.

Article Information

Contributor Notes

Address reprint requests to: Hee-Won Jung, M.D., Ph.D., Department of Neurosurgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110–744, Korea. email: hwnjung@snu.ac.kr.
Headings
References
  • 1.

    Asari SIto TTsuchida Set al: MR appearance and cyst content of Rathke cleft cysts. J Comput Assist Tomogr 14:5325351990Asari S Ito T Tsuchida S et al: MR appearance and cyst content of Rathke cleft cysts. J Comput Assist Tomogr 14:532–535 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Barrow DLSpector RHTakei Yet al: Symptomatic Rathke's cleft cysts located entirely in the suprasellar region: review of diagnosis, management, and pathogenesis. Neurosurgery 16:7667721985Barrow DL Spector RH Takei Y et al: Symptomatic Rathke's cleft cysts located entirely in the suprasellar region: review of diagnosis management and pathogenesis. Neurosurgery 16:766–772 1985

    • Search Google Scholar
    • Export Citation
  • 3.

    Baskin DSWilson CB: Transsphenoidal treatment of non-neoplastic intrasellar cysts. A report of 38 cases. J Neurosurg 60:8131984Baskin DS Wilson CB: Transsphenoidal treatment of non-neoplastic intrasellar cysts. A report of 38 cases. J Neurosurg 60:8–13 1984

    • Search Google Scholar
    • Export Citation
  • 4.

    Brassier GMorandi XTayiar Eet al: Rathke's cleft cysts: surgical-MRI correlation in 16 symptomatic cases. J Neuroradiol 26:1621711999Brassier G Morandi X Tayiar E et al: Rathke's cleft cysts: surgical-MRI correlation in 16 symptomatic cases. J Neuroradiol 26:162–171 1999

    • Search Google Scholar
    • Export Citation
  • 5.

    Byun WMKim OLKim D: MR imaging findings of Rathke's cleft cysts: significance of intracystic nodules. AJNR 21:4854882000Byun WM Kim OL Kim D: MR imaging findings of Rathke's cleft cysts: significance of intracystic nodules. AJNR 21:485–488 2000

    • Search Google Scholar
    • Export Citation
  • 6.

    Eisenberg HMSarwar MSchocher S Jr: Symptomatic Rathke's cleft cyst. Case report. J Neurosurg 45:5855881976Eisenberg HM Sarwar M Schocher S Jr: Symptomatic Rathke's cleft cyst. Case report. J Neurosurg 45:585–588 1976

    • Search Google Scholar
    • Export Citation
  • 7.

    El-Mahdy WPowell M: Transsphenoidal management of 28 symptomatic Rathke's cleft cysts, with special reference to visual and hormonal recovery. Neurosurgery 42:7171998El-Mahdy W Powell M: Transsphenoidal management of 28 symptomatic Rathke's cleft cysts with special reference to visual and hormonal recovery. Neurosurgery 42:7–17 1998

    • Search Google Scholar
    • Export Citation
  • 8.

    Fager CACarter H: Intrasellar epithelial cysts. J Neurosurg 24:77811966Fager CA Carter H: Intrasellar epithelial cysts. J Neurosurg 24:77–81 1966

    • Search Google Scholar
    • Export Citation
  • 9.

    Goodrich JTPost KDDuffy P: Ciliated craniopharyngioma. Surg Neurol 24:1051111985Goodrich JT Post KD Duffy P: Ciliated craniopharyngioma. Surg Neurol 24:105–111 1985

    • Search Google Scholar
    • Export Citation
  • 10.

    Hama SArita KNishisaka Tet al: Changes in the epithelium of Rathke cleft cyst associated with inflammation. J Neurosurg 96:2092162002Hama S Arita K Nishisaka T et al: Changes in the epithelium of Rathke cleft cyst associated with inflammation. J Neurosurg 96:209–216 2002

    • Search Google Scholar
    • Export Citation
  • 11.

    Hama SArita KTominaga Aet al: Symptomatic Rathke's cleft cyst coexisting with central diabetes insipidus and hypophysitis: case report. Endocr J 46:1871921999Hama S Arita K Tominaga A et al: Symptomatic Rathke's cleft cyst coexisting with central diabetes insipidus and hypophysitis: case report. Endocr J 46:187–192 1999

    • Search Google Scholar
    • Export Citation
  • 12.

    Hayashi YTachibana OMuramatsu Net al: Rathke cleft cyst: MR and biomedical analysis of cyst content. J Comput Assist Tomogr 23:34381999Hayashi Y Tachibana O Muramatsu N et al: Rathke cleft cyst: MR and biomedical analysis of cyst content. J Comput Assist Tomogr 23:34–38 1999

    • Search Google Scholar
    • Export Citation
  • 13.

    Ikeda HYoshimoto T: Clinicopathological study of Rathke's cleft cysts. Clin Neuropathol 21:82912002Ikeda H Yoshimoto T: Clinicopathological study of Rathke's cleft cysts. Clin Neuropathol 21:82–91 2002

    • Search Google Scholar
    • Export Citation
  • 14.

    Iraci GGiordano RGerosa Met al: Ocular involvement in recurrent cyst of Rathke's cleft: case report. Ann Ophthalmol 11:94981979Iraci G Giordano R Gerosa M et al: Ocular involvement in recurrent cyst of Rathke's cleft: case report. Ann Ophthalmol 11:94–98 1979

    • Search Google Scholar
    • Export Citation
  • 15.

    Isono MKamida TKobayashi Het al: Clinical features of symptomatic Rathke's cleft cyst. Clin Neurol Neurosurg 103:961002001Isono M Kamida T Kobayashi H et al: Clinical features of symptomatic Rathke's cleft cyst. Clin Neurol Neurosurg 103:96–100 2001

    • Search Google Scholar
    • Export Citation
  • 16.

    Kepes JJ: Transitional cell tumor of the pituitary gland developing from a Rathke's cleft cyst. Cancer 41:3373431978Kepes JJ: Transitional cell tumor of the pituitary gland developing from a Rathke's cleft cyst. Cancer 41:337–343 1978

    • Search Google Scholar
    • Export Citation
  • 17.

    Kleinschmidt-DeMasters BKLillehei KOStears JC: The pathologic, surgical, and MR spectrum of Rathke cleft cysts. Surg Neurol 44:19271995Kleinschmidt-DeMasters BK Lillehei KO Stears JC: The pathologic surgical and MR spectrum of Rathke cleft cysts. Surg Neurol 44:19–27 1995

    • Search Google Scholar
    • Export Citation
  • 18.

    Kucharczyk WPeck WWKelly WMet al: Rathke cleft cysts: CT, MR imaging, and pathologic features. Radiology 165:4914951987Kucharczyk W Peck WW Kelly WM et al: Rathke cleft cysts: CT MR imaging and pathologic features. Radiology 165:491–495 1987

    • Search Google Scholar
    • Export Citation
  • 19.

    Landolt AMZachmann M: Results of transsphenoidal extirpation of craniopharyngiomas and Rathke's cysts. Neurosurgery 28:4104151991Landolt AM Zachmann M: Results of transsphenoidal extirpation of craniopharyngiomas and Rathke's cysts. Neurosurgery 28:410–415 1991

    • Search Google Scholar
    • Export Citation
  • 20.

    Madri JA: Inflammation and healing in Kissane JM (ed): Anderson's Pathologyed 9. St Louis: CV Mosby1990 Vol 1 pp 67110Madri JA: Inflammation and healing in Kissane JM (ed): Anderson's Pathology ed 9. St Louis: CV Mosby 1990 Vol 1 pp 67–110

    • Search Google Scholar
    • Export Citation
  • 21.

    Maggio WWCail WSBrookeman JRet al: Rathke's cleft cyst: computed tomographic and magnetic resonance imaging appearances. Neurosurgery 21:60621987Maggio WW Cail WS Brookeman JR et al: Rathke's cleft cyst: computed tomographic and magnetic resonance imaging appearances. Neurosurgery 21:60–62 1987

    • Search Google Scholar
    • Export Citation
  • 22.

    Marcincin RPGennarelli TA: Recurrence of symptomatic pituitary cysts following transsphenoidal drainage. Surg Neurol 18:4484511982Marcincin RP Gennarelli TA: Recurrence of symptomatic pituitary cysts following transsphenoidal drainage. Surg Neurol 18:448–451 1982

    • Search Google Scholar
    • Export Citation
  • 23.

    Matsushima TFukui MOhta Met al: Ciliated and goblet cells in craniopharyngioma. Light and electron microscopic studies at surgery and autopsy. Acta Neuropathol 50:1992051980Matsushima T Fukui M Ohta M et al: Ciliated and goblet cells in craniopharyngioma. Light and electron microscopic studies at surgery and autopsy. Acta Neuropathol 50:199–205 1980

    • Search Google Scholar
    • Export Citation
  • 24.

    Mukherjee JJIslam NKaltsas Get al: Clinical, radiological and pathological features of patients with Rathke's cleft cysts: tumors that may recur. J Clin Endocrinol Metab 82:235723621997Mukherjee JJ Islam N Kaltsas G et al: Clinical radiological and pathological features of patients with Rathke's cleft cysts: tumors that may recur. J Clin Endocrinol Metab 82:2357–2362 1997

    • Search Google Scholar
    • Export Citation
  • 25.

    Naylor MFScheithauer BWForbes GSet al: Rathke's cleft cyst: CT, MR, and pathology of 23 cases. J Comput Assist Tomogr 19:8538591995Naylor MF Scheithauer BW Forbes GS et al: Rathke's cleft cyst: CT MR and pathology of 23 cases. J Comput Assist Tomogr 19:853–859 1995

    • Search Google Scholar
    • Export Citation
  • 26.

    Nemoto YInoue YFukuda Tet al: MR appearance of Rathke's cleft cysts. Neuroradiology 30:1551591988Nemoto Y Inoue Y Fukuda T et al: MR appearance of Rathke's cleft cysts. Neuroradiology 30:155–159 1988

    • Search Google Scholar
    • Export Citation
  • 27.

    Oka HKawano NSuwa Tet al: Radiological study of symptomatic Rathke's cleft cysts. Neurosurgery 35:6326371994Oka H Kawano N Suwa T et al: Radiological study of symptomatic Rathke's cleft cysts. Neurosurgery 35:632–637 1994

    • Search Google Scholar
    • Export Citation
  • 28.

    Okamoto SHanda HYamashita Jet al: Computed tomography in intra- and suprasellar epithelial cysts (symptomatic Rathke cleft cysts). AJNR 6:5155191985Okamoto S Handa H Yamashita J et al: Computed tomography in intra- and suprasellar epithelial cysts (symptomatic Rathke cleft cysts). AJNR 6:515–519 1985

    • Search Google Scholar
    • Export Citation
  • 29.

    Raskind RBrown HAMathis J: Recurrent cyst of the pituitary: 26-year follow-up from first decompression. Case report. J Neurosurg 28:5955991968Raskind R Brown HA Mathis J: Recurrent cyst of the pituitary: 26-year follow-up from first decompression. Case report. J Neurosurg 28:595–599 1968

    • Search Google Scholar
    • Export Citation
  • 30.

    Ringel SPBailey OT: Rathke's cleft cyst. J Neurol Neurosurg Psychiatry 35:6936971972Ringel SP Bailey OT: Rathke's cleft cyst. J Neurol Neurosurg Psychiatry 35:693–697 1972

    • Search Google Scholar
    • Export Citation
  • 31.

    Ross DANorman DWilson CB: Radiologic characteristics and results of surgical management of Rathke's cysts in 43 patients. Neurosurgery 30:1731791992Ross DA Norman D Wilson CB: Radiologic characteristics and results of surgical management of Rathke's cysts in 43 patients. Neurosurgery 30:173–179 1992

    • Search Google Scholar
    • Export Citation
  • 32.

    Rottenburg GTChong WKPowell Met al: Cyst formation of the craniopharyngeal duct. Clin Radiol 49:1261291994Rottenburg GT Chong WK Powell M et al: Cyst formation of the craniopharyngeal duct. Clin Radiol 49:126–129 1994

    • Search Google Scholar
    • Export Citation
  • 33.

    Rout DDas LRao VRet al: Symptomatic rathke's cleft cysts. Surg Neurol 19:42451983Rout D Das L Rao VR et al: Symptomatic rathke's cleft cysts. Surg Neurol 19:42–45 1983

    • Search Google Scholar
    • Export Citation
  • 34.

    Saeki NSunami KSugaya Yet al: MRI findings and clinical manifestations in Rathke's cleft cyst. Acta Neurochir 141:105510611999Saeki N Sunami K Sugaya Y et al: MRI findings and clinical manifestations in Rathke's cleft cyst. Acta Neurochir 141:1055–1061 1999

    • Search Google Scholar
    • Export Citation
  • 35.

    Shanklin WM: The histogenesis and histology of an integumentary type of epithelium in the human hypophysis. Anat Rec 109:2172311951Shanklin WM: The histogenesis and histology of an integumentary type of epithelium in the human hypophysis. Anat Rec 109:217–231 1951

    • Search Google Scholar
    • Export Citation
  • 36.

    Shanklin WM: The incidence and distribution of cilia in the human pituitary with a distribution of micro-follicular cysts derived from Rathke's cleft. Acta Anat 11:3613821951Shanklin WM: The incidence and distribution of cilia in the human pituitary with a distribution of micro-follicular cysts derived from Rathke's cleft. Acta Anat 11:361–382 1951

    • Search Google Scholar
    • Export Citation
  • 37.

    Shanklin WM: On the presence of cysts in the human pituitary. Anat Rec 104:3794071949Shanklin WM: On the presence of cysts in the human pituitary. Anat Rec 104:379–407 1949

    • Search Google Scholar
    • Export Citation
  • 38.

    Shin JLAsa SLWoodhouse LJet al: Cystic lesions of the pituitary: clinicopathological features distinguishing craniopharyngioma, Rathke's cleft cyst, and arachnoid cyst. J Clin Endocrinol Metab 84:397239821999Shin JL Asa SL Woodhouse LJ et al: Cystic lesions of the pituitary: clinicopathological features distinguishing craniopharyngioma Rathke's cleft cyst and arachnoid cyst. J Clin Endocrinol Metab 84:3972–3982 1999

    • Search Google Scholar
    • Export Citation
  • 39.

    Steinberg GKKoenig GHGolden JB: Symptomatic Rathke's cleft cysts. Report of two cases. J Neurosurg 56:2902951982Steinberg GK Koenig GH Golden JB: Symptomatic Rathke's cleft cysts. Report of two cases. J Neurosurg 56:290–295 1982

    • Search Google Scholar
    • Export Citation
  • 40.

    Sumida MUozumi TMukada Ket al: Rathke cleft cysts: correlation of enhanced MR and surgical findings. AJNR 15:5255321994Sumida M Uozumi T Mukada K et al: Rathke cleft cysts: correlation of enhanced MR and surgical findings. AJNR 15:525–532 1994

    • Search Google Scholar
    • Export Citation
  • 41.

    Trautmann JCLaws ER Jr: Visual status after transsphenoidal surgery at the Mayo Clinic, 1971–1982. Am J Ophthalmol 96:2002081983Trautmann JC Laws ER Jr: Visual status after transsphenoidal surgery at the Mayo Clinic 1971–1982. Am J Ophthalmol 96:200–208 1983

    • Search Google Scholar
    • Export Citation
  • 42.

    Verkijk ABots GT: An intrasellar cyst with both Rathke's cleft and epidermoid characteristics. Acta Neurochir 51:2032071980Verkijk A Bots GT: An intrasellar cyst with both Rathke's cleft and epidermoid characteristics. Acta Neurochir 51:203–207 1980

    • Search Google Scholar
    • Export Citation
  • 43.

    Voelker JLCampbell RLMuller J: Clinical, radiographic, and pathological features of symptomatic Rathke's cleft cysts. J Neurosurg 74:5355441991Voelker JL Campbell RL Muller J: Clinical radiographic and pathological features of symptomatic Rathke's cleft cysts. J Neurosurg 74:535–544 1991

    • Search Google Scholar
    • Export Citation
  • 44.

    Wagle VGNelson DRossi Aet al: Magnetic resonance imaging of symptomatic Rathke's cleft cyst: report of a case. Neurosurgery 24:2762781989Wagle VG Nelson D Rossi A et al: Magnetic resonance imaging of symptomatic Rathke's cleft cyst: report of a case. Neurosurgery 24:276–278 1989

    • Search Google Scholar
    • Export Citation
  • 45.

    Wearne MJBarber PCJohnson AP: Symptomatic Rathke's cleft cyst with hypophysitis. Br J Neurosurg 9:7998031995Wearne MJ Barber PC Johnson AP: Symptomatic Rathke's cleft cyst with hypophysitis. Br J Neurosurg 9:799–803 1995

    • Search Google Scholar
    • Export Citation
  • 46.

    Wenzel MSalcman MKristt DAet al: Pituitary hyposecretion and hypersecretion produced by Rathke's cleft cyst presenting as a noncystic hypothalamic mass. Neurosurgery 24:4244281989Wenzel M Salcman M Kristt DA et al: Pituitary hyposecretion and hypersecretion produced by Rathke's cleft cyst presenting as a noncystic hypothalamic mass. Neurosurgery 24:424–428 1989

    • Search Google Scholar
    • Export Citation
  • 47.

    Yamamoto MJimbo MIde Met al: Recurrence of symptomatic Rathke's cleft cyst: a case report. Surg Neurol 39:2632681993Yamamoto M Jimbo M Ide M et al: Recurrence of symptomatic Rathke's cleft cyst: a case report. Surg Neurol 39:263–268 1993

    • Search Google Scholar
    • Export Citation
  • 48.

    Yoshida JKobayashi TKageyama Net al: Symptomatic Rathke's cleft cyst. Morphological study with light and electron microscopy and tissue culture. J Neurosurg 47:4514581977Yoshida J Kobayashi T Kageyama N et al: Symptomatic Rathke's cleft cyst. Morphological study with light and electron microscopy and tissue culture. J Neurosurg 47:451–458 1977

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 204 138 9
Full Text Views 136 28 2
PDF Downloads 144 32 2
EPUB Downloads 0 0 0
PubMed
Google Scholar