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

Contributor Notes

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.
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References
  • 1

    Alahmadi HDehdashti ARGentili F: Endoscopic endonasal surgery in recurrent and residual pituitary adenomas after microscopic resection. World Neurosurg 77:5405472012

    • Search Google Scholar
    • Export Citation
  • 2

    Amendola BEWolf ACoy SRAmendola MA: Role of radiosurgery in craniopharyngiomas: a preliminary report. Med Pediatr Oncol 41:1231272003

    • Search Google Scholar
    • Export Citation
  • 3

    Benveniste RJKing WAWalsh JLee JSDelman BNPost KD: Repeated transsphenoidal surgery to treat recurrent or residual pituitary adenoma. J Neurosurg 102:100410122005

    • Search Google Scholar
    • Export Citation
  • 4

    Cavallo LMSolari DTasiou AEsposito Fde Angelis MD’Enza AI: Endoscopic endonasal transsphenoidal removal of recurrent and regrowing pituitary adenomas: experience on a 59-patient series. World Neurosurg 80:3423502013

    • Search Google Scholar
    • Export Citation
  • 5

    Chang EFSughrue MEZada GWilson CBBlevins LS JrKunwar S: Long term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas. Pituitary 13:2232292010

    • Search Google Scholar
    • Export Citation
  • 6

    Constine LSRandall SHRubin PMcDonald J: Craniopharyngiomas: fluctuation in cyst size following surgery and radiation therapy. Neurosurgery 24:53591989

    • Search Google Scholar
    • Export Citation
  • 7

    Do HKshettry VRSiu ABelinsky IFarrell CJNyquist G: Extent of resection, visual, and endocrinologic outcomes for endoscopic endonasal surgery for recurrent pituitary adenomas. World Neurosurg 102:35412017

    • Search Google Scholar
    • Export Citation
  • 8

    Fisch BMSneed PLarson DAWara W: Radiation therapy for Rathke’s cleft cyst. Cancer J 7:5385392001

  • 9

    Hiniker SMModlin LAChoi CYAtalar BSeiger KBinkley MS: Dose-response modeling of the visual pathway tolerance to single-fraction and hypofractionated stereotactic radiosurgery. Semin Radiat Oncol 26:971042016

    • Search Google Scholar
    • Export Citation
  • 10

    Hwang JMKim YHKim JWKim DGJung HWChung YS: Feasibility of endoscopic endonasal approach for recurrent pituitary adenomas after microscopic trans-sphenoidal approach. J Korean Neurosurg Soc 54:3173222013

    • Search Google Scholar
    • Export Citation
  • 11

    Jahangiri AWagner JHan SWZygourakis CCHan SJTran MT: Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations. J Neurosurg 121:67742014

    • Search Google Scholar
    • Export Citation
  • 12

    Kinoshita YTominaga AUsui SArita KSakoguchi TSugiyama K: The long-term recurrence of Rathke’s cleft cysts as predicted by histology but not by surgical procedure. J Neurosurg 125:100210072016

    • Search Google Scholar
    • Export Citation
  • 13

    Kobayashi TTsugawa THatano MHashizume CMori YShibamoto Y: Gamma knife radiosurgery of craniopharyngioma: results of 30 cases treated at Nagoya Radiosurgery Center. Nagoya J Med Sci 77:4474542015

    • Search Google Scholar
    • Export Citation
  • 14

    Lillehei KOWiddel LAstete CAWierman 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
  • 15

    Milano MTGrimm JSoltys SGYorke EMoiseenko VTomé WA: Single- and multi-fraction stereotactic radiosurgery dose tolerances of the optic pathways. Int J Radiat Oncol [epub ahead of print] 2018

    • Search Google Scholar
    • Export Citation
  • 16

    Niranjan AKano HMathieu DKondziolka DFlickinger JCLunsford LD: Radiosurgery for craniopharyngioma. Int J Radiat Oncol Biol Phys 78:64712010

    • Search Google Scholar
    • Export Citation
  • 17

    Pettorini BLInzitari RMassimi LTamburrini GCaldarelli MFanali C: The role of inflammation in the genesis of the cystic component of craniopharyngiomas. Childs Nerv Syst 26:177917842010

    • Search Google Scholar
    • Export Citation
  • 18

    Sheehan JPStarke RMMathieu DYoung BSneed PKChiang VL: Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study. J Neurosurg 119:4464562013

    • Search Google Scholar
    • Export Citation
  • 19

    Tajudeen BAMundi JSuh JDBergsneider MWang MB: Endoscopic endonasal surgery for recurrent pituitary tumors: technical challenges to the surgical approach. J Neurol Surg B Skull Base 76:50562015

    • Search Google Scholar
    • Export Citation
  • 20

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

  • 21

    Wajima DYonezawa TMasui KAketa S: Relationship between clinical features and T2-weighted magnetic resonance images in symptomatic Rathke cleft cysts. World Neurosurg 88:4214272016

    • Search Google Scholar
    • Export Citation
  • 22

    Winkfield KMLinsenmeier CYock TIGrant PEYeap BYButler WE: Surveillance of craniopharyngioma cyst growth in children treated with proton radiotherapy. Int J Radiat Oncol Biol Phys 73:7167212009

    • Search Google Scholar
    • Export Citation
  • 23

    Yomo SHayashi MChernov MTamura NIzawa MOkada Y: Stereotactic radiosurgery of residual or recurrent craniopharyngioma: new treatment concept using Leksell Gamma Knife model C with automatic positioning system. Stereotact Funct Neurosurg 87:3603672009

    • Search Google Scholar
    • Export Citation
  • 24

    Yu XHuang RQian WFang JWu CLiu S: Stereotactic radiosurgery to treat presumed Rathke’s cleft cysts. Br J Neurosurg 26:6846912012

    • Search Google Scholar
    • Export Citation
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