Rathke’s cleft cysts with significant squamous metaplasia—high risk of postoperative deterioration and close origins to craniopharyngioma

2013 ◽  
Vol 155 (6) ◽  
pp. 1069-1075 ◽  
Author(s):  
Yoshikazu Ogawa ◽  
Mika Watanabe ◽  
Teiji Tominaga
Keyword(s):  
High Risk ◽  
Squamous Metaplasia ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft

Recurrent Rathke's Cleft Cysts: Incidence and Surgical Management in a Tertiary Pituitary Center over 2 Decades

2018 ◽  
Vol 16 (6) ◽  
pp. 675-684 ◽  
Author(s):  
Michelle A Wedemeyer ◽  
Michelle Lin ◽  
Vance L Fredrickson ◽  
Anush Arakelyan ◽  
Daniel Bradley ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Vision Loss ◽  
Squamous Metaplasia ◽  
Cerebrospinal Fluid Leak ◽  
Pathological Examination ◽  
Limited Data ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft ◽  
Fluid Leak

Abstract Background Limited data exist pertaining to outcomes following surgery for recurrent Rathke's cleft cysts (RCC). Objective To determine treatment outcomes in patients undergoing reoperation for recurrent or residual RCCs. Methods A retrospective analysis of 112 consecutive RCC operations in 109 patients between 1995 and 2017 was conducted. Results Eighteen patients underwent 21 RCC reoperations with a mean follow-up of 58 mo. Patient symptoms prior to reoperation included headaches (14, 66.7%) and vision loss (12, 57.1%). Thirteen of 18 patients (72.2%) required hormone supplementation prior to reoperation including 5 with diabetes insipidus (DI). Mean RCC diameter was 16 mm and 76% had suprasellar extension. Compared to index RCC cases, intraoperative cerebrospinal fluid leak repair was more common in reoperation cases (15/21, 71% vs 43/91, 47%, P = .05). There was 1 carotid artery injury without neurological sequelae, and 2 postoperative cerebrospinal fluid (CSF) leaks (9.5%). Rates of transient hyponatremia (3/10, 30% vs 4/91, 4.4%, P = .04) and transient DI (5/10, 50% vs 17/91, 18.7%, P = .04) were higher in the reoperation vs index group. Improved headaches and vision were reported in 4/12 (33%) and 8/12 (61.5%) of RCC reoperation patients, respectively. Two patients developed new permanent DI. A higher proportion of reoperation patients had RCC squamous metaplasia (24% vs 5.4%, P = .02) or wall inflammation (42.9% vs 2.2%, P < .001) on pathological examination. CONCLUSION Reoperation for RCCs is generally safe at tertiary pituitary centers and often results in improved vision. Hypopituitarism is less likely to improve following reoperation for recurrent RCCs. Several histopathological features may help characterize “atypical RCCs” with a higher likelihood of recurrence/progression.

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

2016 ◽  
Vol 125 (4) ◽  
pp. 1002-1007 ◽  
Author(s):  
Yasuyuki Kinoshita ◽  
Atsushi Tominaga ◽  
Satoshi Usui ◽  
Kazunori Arita ◽  
Tetsuhiko Sakoguchi ◽  
...  
Keyword(s):  
Surgical Procedure ◽  
Squamous Metaplasia ◽  
Visual Disturbance ◽  
Initial Surgery ◽  
Long Term Follow Up ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft ◽  
Term Monitoring

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.

scholarly journals Rathke’s cleft cyst with xanthogranulomatous change: A case report and review of the literature

2020 ◽  
Vol 11 ◽  
pp. 246
Author(s):  
Annelise Sprau ◽  
Anil Mahavadi ◽  
Michael Zhang ◽  
Micah Saste ◽  
Michael Deftos ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Squamous Metaplasia ◽  
Delayed Puberty ◽  
Endoscopic Endonasal ◽  
Sellar Lesions ◽  
Rathke's Cleft Cysts ◽  
Small Cohort ◽  
Rathke's Cleft

Background: Rathke’s cleft cysts (RCCs) are benign, typically asymptomatic sellar lesions found incidentally in adults, with a dramatically lower incidence in pediatric patients (<18 years). We present a case of RCC with xanthogranulomatous change (XGC) – an even less common subtype of RCC – treated by endoscopic endonasal surgical resection. This is the second reported instance of an RCC with XGC occurring in a pediatric patient. Case Description: The patient is a 17-year-old male with delayed puberty who presented with bitemporal hemianopsia and was found to have a 2.6 cm lesion, initially thought to be a craniopharyngioma. He subsequently underwent uncomplicated transsphenoidal endoscopic endonasal resection. Histology confirmed the diagnosis of RCC and demonstrated marked degenerative XGCs with squamous metaplasia. The patient tolerated the procedure well with improvement in visual symptoms. Conclusion: RCC with XGC is a very rare pathology, particularly in the pediatric population. These lesions, while benign, can manifest clinically with significant symptoms. While treatment paradigms are not fully established with a small cohort of cases, endoscopic endonasal approaches have made surgical resection of these lesions a safe and effective treatment strategy, even in the pediatric population.

Treatment Outcomes of Rathke’s Cleft Cysts Managed with Marsupialization

2016 ◽  
Vol 77 (S 01) ◽  
Author(s):  
Edward Kuan ◽  
Frederick Yoo ◽  
Marvin Bergsneider ◽  
Marilene Wang
Keyword(s):  
Treatment Outcomes ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft

Recurrence of Rathke’s Cleft Cysts Based on Gross Total Resection of Cyst Wall: A Meta-analysis

2020 ◽  
Author(s):  
Victor Lu ◽  
Avital Perry ◽  
Christopher Graffeo ◽  
Krishnan Ravindran ◽  
Jamie Van Gompel
Keyword(s):  
Cyst Wall ◽  
Meta Analysis ◽  
Gross Total Resection ◽  
Total Resection ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft

Clinico-pathological differentiation of cystic craniopharyngiomas from Rathke's cleft cysts

2006 ◽  
Vol 114 (S 1) ◽  
Author(s):  
B Hofmann ◽  
J Kreutzer ◽  
W Saeger ◽  
I Blümcke ◽  
R Fahlbusch ◽  
...  
Keyword(s):  
Pathological Differentiation ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft

Stereotactic radiosurgery to treat presumed Rathke's cleft cysts

2012 ◽  
Vol 26 (5) ◽  
pp. 684-691 ◽  
Author(s):  
Xin Yu ◽  
Runsheng Huang ◽  
Wei Qian ◽  
Jingyu Fang ◽  
Caizhen Wu ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft

An isolated primary Rathke's cleft cyst in the cerebellopontine angle

2014 ◽  
Vol 121 (4) ◽  
pp. 846-850 ◽  
Author(s):  
Jun Fan ◽  
Songtao Qi ◽  
Yuping Peng ◽  
Xi-an Zhang ◽  
Binghui Qiu ◽  
...  
Keyword(s):  
Cerebellopontine Angle ◽  
Imaging Features ◽  
Good Recovery ◽  
Suprasellar Region ◽  
Adjacent Structures ◽  
Facial Numbness ◽  
History Of ◽  
Rathke's Cleft Cysts ◽  
Rathke's Cleft

Rathke's cleft cysts (RCCs) are benign cysts typically located in the sellar or suprasellar region; ectopic isolated lesions are extremely rare. The authors describe the case of a 25-year-old man with a giant symptomatic RCC arising primarily at the cerebellopontine angle (CPA), only the second case reported thus far. The patient presented with a 2-year history of right hearing impairment and tinnitus accompanied by vertigo and headache and a 2-week history of right facial numbness. Subsequently, he underwent total cyst removal via retrosigmoid craniotomy with a good recovery. He experienced no recurrence during a 64-month follow-up period. The possible pathogenesis, differential diagnosis, and surgical treatment of such cysts are discussed in this article. Isolated ectopic RCCs can arise from the ectopic migration of Rathke's pouch cells during the embryonic period. It is still difficult to distinguish ectopic RCCs from other cystic lesions of the CPA given the lack of specific imaging features. Aggressive resection of the cyst wall is not recommended, except when lesions do not closely adhere to adjacent structures.

Sign in / Sign up

Export Citation Format

Share Document