Rathke’s cleft cysts following transsphenoidal surgery: long-term outcomes and development of an optimal follow-up strategy

ObjectiveTo clarify the outcome of all cases of Rathke's cleft cysts (RCC) treated surgically and followed up in Oxford during a long-term period.Subjects and methodsThe records of all patients with RCC seen in the Department of Endocrinology between January 1978 and June 2009 were reviewed.ResultsA total of 33 patients (20 females, median age 43 years) were identified. At presentation, major visual field defects were detected in 58% of patients and gonadotrophin, ACTH and TSH deficiency in 60, 36 and 36% of patients respectively. Desmopressin treatment was required in 18% of patients. Treatment consisted of cyst evacuation combined with or without biopsy/removal of the wall. Post-operatively, visual fields improved in 83% of patients with impairment, whereas there was no reversal of ACTH or TSH deficiency or of diabetes insipidus. All but one subject had imaging follow-up during a mean period of 48 months (range 2–267). Cyst relapse was detected in 22% of patients at a mean interval of 29 months (range 3–48 months); in 57% of them, the recurrence was symptomatic. Relapse-free rates were 88% at 24-months and 52% at 48-months follow-up. At last assessment, at least quadrantanopia was reported in 19% of patients, gonadotrophin, ACTH and TSH deficiency in 50, 42 and 47% of patients respectively. Desmopressin treatment was required in 39% of patients.ConclusionsIn this study of patients with RCC and long-term follow-up, we showed a considerable relapse rate necessitating long-term monitoring. Surgical intervention is of major importance for the restoration of visual field defects, but it does not improve endocrine morbidity, which in the long-term affects a substantial number of patients.

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Early Morning Cortisol Levels as Predictors of Short- and Long-Term Adrenal Function after Endonasal Transsphenoidal Surgery for Pituitary Adenomas and Rathke's Cleft Cysts

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0032-1312080 ◽

2012 ◽

Vol 73 (S 01) ◽

Author(s):

Nancy McLaughlin ◽

Pejman Cohan ◽

Philip Barnett ◽

Amy Eisenberg ◽

Charlene Chaloner ◽

...

Keyword(s):

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Early Morning ◽

Adrenal Function ◽

Morning Cortisol ◽

Rathke's Cleft Cysts ◽

Short And Long Term ◽

Cortisol Levels ◽

Rathke's Cleft

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Long-term surgical outcomes following transsphenoidal surgery in patients with Rathke’s cleft cysts

Journal of Neurosurgery ◽

10.3171/2017.11.jns171498 ◽

2019 ◽

Vol 130 (3) ◽

pp. 831-837 ◽

Cited By ~ 7

Author(s):

Michelle Lin ◽

Michelle A. Wedemeyer ◽

Daniel Bradley ◽

Daniel A. Donoho ◽

Vance L. Fredrickson ◽

...

Keyword(s):

Transsphenoidal Approach ◽

Neurological Deficits ◽

Csf Leak ◽

Rathke's Cleft Cysts ◽

The Mean ◽

Rathke's Cleft ◽

Cyst Fenestration ◽

Csf Leaks

OBJECTIVERathke’s cleft cysts (RCCs) are benign epithelial lesions of the sellar region typically treated via a transsphenoidal approach with cyst fenestration and drainage. At present, there is limited evidence to guide patient selection for operative treatment. Furthermore, there is minimal literature describing factors contributing to cyst recurrence.METHODSThe authors conducted a retrospective analysis of 109 consecutive cases of pathology-confirmed RCCs treated via a transsphenoidal approach at a single center from 1995 to 2016. The majority of cases (86.2%) involved cyst fenestration, drainage, and partial wall resection. Long-term outcomes were analyzed.RESULTSA total of 109 surgeries in 100 patients were included, with a mean follow-up duration of 67 months (range 3–220 months). The mean patient age was 44.6 years (range 12–82 years), and 73% were women. The mean maximal cyst diameter was 14.7 mm. Eighty-eight cases (80.7%) were primary operations, and 21 (19.3%) were reoperations. Intraoperative CSF leak repair was performed in 53% of cases and was more common in reoperation cases (71% vs 48%, p < 0.001). There were no new neurological deficits or perioperative deaths. Two patients (1.8%) developed postoperative CSF leaks. Transient diabetes insipidus (DI) developed in 24 cases (22%) and permanent DI developed in 6 (5.5%). Seven cases (6.4%) developed delayed postoperative hyponatremia. Of the 66 patients with preoperative headache, 27 (44.3%) of 61 reported postoperative improvement and 31 (50.8%) reported no change. Of 31 patients with preoperative vision loss, 13 (48.1%) reported subjective improvement and 12 (44.4%) reported unchanged vision. Initial postoperative MRI showed a residual cyst in 25% of cases and no evidence of RCC in 75% of cases. Imaging revealed evidence of RCC recurrence or progression in 29 cases (26.6%), with an average latency of 28.8 months. Of these, only 10 (9.2% of the total 109 cases) were symptomatic and underwent reoperation.CONCLUSIONSTranssphenoidal fenestration and drainage of RCCs is a safe and effective intervention for symptomatic lesions, with many patients experiencing improvement of headaches and vision. RCCs show an appreciable (although usually asymptomatic) recurrence rate, thereby mandating serial follow-up. Despite this, full RCC excision is typically not recommended due to risk of hypopituitarism, DI, and CSF leaks.

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Early Morning Cortisol Levels as Predictors of Short-Term and Long-Term Adrenal Function After Endonasal Transsphenoidal Surgery for Pituitary Adenomas and Rathke’s Cleft Cysts

World Neurosurgery ◽

10.1016/j.wneu.2012.07.034 ◽

2013 ◽

Vol 80 (5) ◽

pp. 569-575 ◽

Cited By ~ 22

Author(s):

Nancy McLaughlin ◽

Pejman Cohan ◽

Philip Barnett ◽

Amy Eisenberg ◽

Charlene Chaloner ◽

...

Keyword(s):

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Early Morning ◽

Adrenal Function ◽

Short Term ◽

Morning Cortisol ◽

Rathke's Cleft Cysts ◽

Cortisol Levels ◽

Rathke's Cleft

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

Journal of Neurosurgery ◽

10.3171/2015.8.jns151282 ◽

2016 ◽

Vol 125 (4) ◽

pp. 1002-1007 ◽

Cited By ~ 9

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.

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The Long-term Follow-up Result of Rathke's Cleft Cysts

Japanese Journal of Neurosurgery ◽

10.7887/jcns.15.408 ◽

2006 ◽

Vol 15 (5) ◽

pp. 408-414

Author(s):

Sunao Takemura ◽

Shinya Sato ◽

Kaori Sakurada ◽

Takamasa Kayama

Keyword(s):

Long Term Follow Up ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft

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Two cases of symptomatic secondary hypophysitis due to Rathke’s cleft cysts treated with glucocorticoids: long-term follow-up

Endocrine Journal ◽

10.1507/endocrj.ej20-0361 ◽

2020 ◽

Author(s):

Hanna Deguchi-Horiuchi ◽

Hisashi Koide ◽

Ikki Sakuma ◽

Yue Gao ◽

Seiichiro Higuchi ◽

...

Keyword(s):

Long Term Follow Up ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft

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Periprocedural risk and long-term outcome of intracranial angioplasty based on a single-centre experience

VASA ◽

10.1024/0301-1526/a000287 ◽

2013 ◽

Vol 42 (4) ◽

pp. 264-274

Author(s):

Dagmar Krajíčková ◽

Antonín Krajina ◽

Miroslav Lojík ◽

Martina Mulačová ◽

Martin Vališ

Keyword(s):

Death Rate ◽

Long Term Outcomes ◽

Single Centre ◽

Intracranial Atherosclerotic Stenosis ◽

Atherosclerotic Stenosis ◽

Angioplasty And Stenting ◽

Aggressive Medical Management ◽

Stroke Death

Background: Intracranial atherosclerotic stenosis is a major cause of stroke and yet there are currently no proven effective treatments for it. The SAMMPRIS trial, comparing aggressive medical management alone with aggressive medical management combined with intracranial angioplasty and stenting, was prematurely halted when an unexpectedly high rate of periprocedural events was found in the endovascular arm. The goal of our study is to report the immediate and long-term outcomes of patients with ≥ 70 % symptomatic intracranial atherosclerotic stenosis treated with balloon angioplasty and stent placement in a single centre. Patients and methods: This is a retrospective review of 37 consecutive patients with 42 procedures of ballon angioplasty and stenting for intracranial atherosclerotic stenosis (≥ 70 % stenosis) treated between 1999 and 2012. Technical success (residual stenosis ≤ 50 %), periprocedural success (no vascular complications within 72 hours), and long-term outcomes are reported. Results: Technical and periprocedural success was achieved in 90.5 % of patients. The within 72 hours periprocedural stroke/death rate was 7.1 % (4.8 % intracranial haemorrhage), and the 30-day stroke/death rate was 9.5 %. Thirty patients (81 %) had clinical follow-up at ≥ 6 months. During follow-up, 5 patients developed 6 ischemic events; 5 of them (17 %) were ipsilateral. The restenosis rate was 27 %, and the retreatment rate was 12 %. Conclusions: Our outcomes of the balloon angioplasty/stent placement for intracranial atherosclerotic stenosis are better than those in the SAMMPRIS study and compare favourably with those in large registries and observational studies.

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