Clinical, radiographic, and pathological features of symptomatic Rathke's cleft cysts

✓ The clinical, radiographic, and pathological findings in 155 patients with symptomatic Rathke's cleft cysts are discussed. Eight patients were treated by the authors and 147 were collected in a review of the literature. This lesion occurred more often in female than male patients by a 2:1 margin, and the mean age at presentation was 38 years. The average patient had been symptomatic for nearly 3 years at the time of treatment, with the most common symptoms and signs being pituitary dysfunction, visual disturbances, and headaches. Affected children generally were pituitary dwarfs. The sella was enlarged in 80% of cases, and the cyst was situated in both an intrasellar and a suprasellar location in 71%. Computerized tomography revealed a low-density cystic mass with capsular enhancement in one-half of the cases. A variable appearance was seen with magnetic resonance imaging. Partial excision and drainage of the cyst by the transsphenoidal approach is the recommended treatment, as the recurrence rate is low. Most symptoms and signs improved or resolved following surgery with the exception of hypopituitarism and diabetes insipidus. The cyst lining was usually composed of ciliated cuboidal or columnar epithelium. Theories as to the origin of Rathke's cleft cysts are also discussed.

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Endoscopic Transsphenoidal Cisternostomy for Nonneoplastic Sellar Cysts

BioMed Research International ◽

10.1155/2015/389474 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Yukai Su ◽

Yudo Ishii ◽

Chien-Min Lin ◽

Shigeyuki Tahara ◽

Akira Teramoto ◽

...

Keyword(s):

Recurrence Rate ◽

Clinical Presentation ◽

Arachnoid Cysts ◽

Invasive Approach ◽

Csf Fistula ◽

Pituitary Dysfunction ◽

Operative Complications ◽

Rathke's Cleft Cysts ◽

Fistula Rate ◽

Rathke's Cleft

Background and Importance. Sellar arachnoid cysts and Rathke’s cleft cysts are benign lesions that produce similar symptoms, including optochiasmatic compression, pituitary dysfunction, and headache. Studies have reported the use of various surgical treatment methods for treating these symptoms, preventing recurrence, and minimizing operative complications. However, the postoperative cerebrospinal fluid (CSF) fistula and recurrence rate remain significant.Clinical Presentation. In this paper, we present 8 consecutive cases involving arachnoid cysts and Rathke’s cleft cysts, which were managed by using drainage and cisternostomy, the intentional fenestration of the cyst into the subarachnoid space, and then meticulously closing sellar floor using dural sutures. The postoperative images, CSF fistula rate, and the recurrence rate were favorable.Conclusion. We report this technique and discuss the benefit of this minimally invasive approach.

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Risk factor for pituitary dysfunction in children and adolescents with Rathke's cleft cysts

Korean Journal of Pediatrics ◽

10.3345/kjp.2010.53.7.759 ◽

2010 ◽

Vol 53 (7) ◽

pp. 759 ◽

Cited By ~ 14

Author(s):

Han Hyuk Lim ◽

Sei Won Yang

Keyword(s):

Risk Factor ◽

Children And Adolescents ◽

Pituitary Dysfunction ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft

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Colloid cyst of the third ventricle

Journal of Neurosurgery ◽

10.3171/jns.1993.78.1.0101 ◽

1993 ◽

Vol 78 (1) ◽

pp. 101-111 ◽

Cited By ~ 74

Author(s):

Boleslaw Lach ◽

Bernd W. Scheithauer ◽

Alistair Gregor ◽

Mark R. Wick

Keyword(s):

Choroid Plexus ◽

Ricinus Communis ◽

Neuron Specific Enolase ◽

Pars Intermedia ◽

Content Type ◽

S 100 ◽

Rathke's Cleft Cysts ◽

Colloid Cysts ◽

Rathke's Cleft ◽

Choroid Plexus Papillomas

✓ In an effort to shed light upon the nature of the colloid cyst, the immunohistochemical properties of 21 examples of this lesion were compared with those of other neuraxial cysts and choroid plexus epithelium. The neuraxial cysts included the following: eight Rathke's cleft cysts, 25 pituitaries containing follicular cysts of the pars intermedia, and four enterogenous cysts. Fifteen examples of normal choroid plexus and 12 choroid plexus papillomas were studied as well. These lesions were examined for localization of the following antigens: cytokeratins, epithelial membrane antigen, secretory component, carcinoembryonic antigen, prealbumin, vimentin, glial fibrillary acidic protein (GFAP), S-100 protein, neuron-specific enolase, 68-kD neurofilament protein, chromogranin, serotonin, and lysozyme, and with Leu-7 monoclonal antibodies. Five colloid cysts were immunostained with monoclonal antibodies that were specific for Clara-cell antigens and surfactant, respectively. Sugar moieties were localized using Ulex europaeus I, and Ricinus communis agglutinin I lectins. All Rathke's cleft cysts and follicular cysts of the pars intermedia as well as three selected colloid cysts were examined for pituitary hormones. The epithelial cells of colloid and enterogenous cysts, as well as those lining follicular and Rathke's cleft cyst, showed uniformly strong reactivity for cytokeratins, epithelial membrane antigen, secretory component, and vimentin, and bound Ulex europaeus lectin. Occasional cells in colloid cysts were positive for Clara cell-specific antigens. Reaction for carcinoembryonic antigen was present on the apical surface of scattered cells of colloid, follicular, and Rathke's cleft cysts. Many cells of follicles in the pars intermedia as well as individual cells of five Rathke's cleft cysts were also immunoreactive for chromogranin, S-100 protein, GFAP, and pituitary hormones. Colloid and enterogenous cysts were negative for prealbumin, S-100 protein, GFAP, and neuron-specific enolase; in all but a few instances, they failed to bind Ricinus communis agglutinin. In contrast, normal choroid plexus and choroid plexus papillomas were positive for prealbumin, S-100 protein, neuron-specific enolase, cytokeratin, vimentin, and Ricinus communis agglutinin receptors; they lacked Ulex europaeus lectin, 56/66-kD cytokeratins, and epithelial membrane antigen. Unlike normal choroid plexus, choroid plexus papillomas were often GFAP-positive. All tissues studied were nonreactive for lysosome, serotonin, and neurofilament, and with Leu-7 antibodies. This study indicates that the immunophenotype of epithelium lining colloid cysts is similar to that of other cysts showing endodermal or ectodermal differentiation and to respiratory tract mucosa. Epithelium of colloid cysts is immunohistochemically different from that of normal or neoplastic choroid plexus. These findings indicate an endodermal rather than neuroepithelial nature for colloid cysts.

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Transsphenoidal Endoscopic Approach in the Treatment of Rathke's Cleft Cyst

Neurosurgery ◽

10.1227/01.neu.0000144824.80046.1f ◽

2005 ◽

Vol 56 (1) ◽

pp. 124-129 ◽

Cited By ~ 66

Author(s):

Giorgio Frank ◽

Vittorio Sciarretta ◽

Diego Mazzatenta ◽

Giovanni Farneti ◽

Giovanni Carlo Modugno ◽

...

Keyword(s):

Diabetes Insipidus ◽

Visual Impairment ◽

Endoscopic Approach ◽

Rathke’S Cleft Cyst ◽

Rathke's Cleft Cyst ◽

Invasive Approach ◽

Pituitary Dysfunction ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft

Abstract OBJECTIVE: In this study, the usefulness of the transsphenoidal endoscopic approach in the treatment of a Rathke's cleft cyst is reported. METHODS: Between June 1998 and December 2002, 22 patients affected by sellar-suprasellar Rathke's cleft cysts were treated using a transsphenoidal endoscopic approach. Fourteen patients experienced pituitary dysfunction (64%), five experienced visual impairment (23%), and three reported headaches (14%). RESULTS: The patient follow-up ranged from 8 to 60 months (mean, 33 mo). Pituitary function was restored only in the four patients with hyperprolactinemia, whereas visual impairment and headache improved in all patients. However, when present before surgery, hypopituitarism was unaffected by surgery. Two patients experienced permanent diabetes insipidus (one of them before surgery). Only one recurrence was observed in a 13-year-old girl at 12 months after surgery, and it was treated using a new transsphenoidal endoscopic approach. CONCLUSION: The transsphenoidal endoscopic approach represents a straightforward and mini-invasive approach for the drainage and biopsy of a Rathke's cleft cyst.

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Rathke’s Cleft Cysts

10.1093/med/9780190696696.003.0017 ◽

2018 ◽

Author(s):

Ian A. Buchanan ◽

Gabriel Zada

Keyword(s):

Complete Resection ◽

Management Technique ◽

Visual Deficits ◽

Rathke Cleft Cyst ◽

Pituitary Dysfunction ◽

Rathke's Cleft Cysts ◽

Transphenoidal Approach ◽

Autopsy Specimens ◽

Rathke's Cleft ◽

Cyst Fenestration

Cystic lesions involving the sella have a distinct differential diagnosis including Rathke cleft cyst, cystic pituitary adenoma, craniopharyngioma, arachnoid cyst, and epidermoid among other entities. Workup includes not only cranial imaging but also endocrine evaluation for pituitary dysfunction and ophthalmologic evaluation to assess for visual deficits that may not be immediately apparent to the patient at presentation. Rathke cleft cysts are common and may be found in 20% of autopsy specimens. However, symptomatic Rathke cleft cysts are rare, and surgical decisions should be made judiciously based on preoperative symptoms and workup. Endonasal transphenoidal approach for cyst fenestration is a common surgical management technique for symptomatic lesions. Complete resection of the Rathke cleft cyst wall is not required.

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Symptomatic Rathke's cleft cysts

Journal of Neurosurgery ◽

10.3171/jns.1982.56.2.0290 ◽

1982 ◽

Vol 56 (2) ◽

pp. 290-295 ◽

Cited By ~ 66

Author(s):

Gary K. Steinberg ◽

George H. Koenig ◽

James B. Golden

Keyword(s):

Computerized Tomography ◽

Aseptic Meningitis ◽

Content Type ◽

Visual Symptoms ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft ◽

Recurrent Aseptic Meningitis ◽

Suprasellar Extension ◽

Fine Print

✓ Two unusual cases of symptomatic Rathke's cleft cysts are described. The first patient was a 47-year-old man who presented with recurrent aseptic meningitis in addition to visual symptoms, panhypopituitarism, and hydrocephalus. The second patient was a 41-year-old man presenting with increasing headache, and a large, nonenhancing sellar cyst showing suprasellar extension on computerized tomography. The similarities between Rathke's cleft cysts and craniopharyngiomas are discussed.

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Transsphenoidal treatment of non-neoplastic intrasellar cysts

Journal of Neurosurgery ◽

10.3171/jns.1984.60.1.0008 ◽

1984 ◽

Vol 60 (1) ◽

pp. 8-13 ◽

Cited By ~ 85

Author(s):

David S. Baskin ◽

Charles B. Wilson

Keyword(s):

Cyst Wall ◽

Normal Function ◽

Serum Prolactin ◽

Pars Intermedia ◽

Surgical Morbidity ◽

Content Type ◽

Adrenal Hypofunction ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft

✓ Thirty-eight patients underwent transsphenoidal microsurgical treatment of non-neoplastic intrasellar cysts: 36 had cyst drainage and biopsy of the cyst wall, and in two the cyst was totally removed. Surgical morbidity was 8%. The mean follow-up time was 46.3 months; 100% patient follow-up evaluation was achieved. Sixteen female patients (mean age 24.6 years) had pars intermedia cysts: 88% had menstrual irregularities, 63% had galactorrhea, 31% had headache, and 56% had hyperprolactinemia. Within these groups, menstrual cycles returned in 86%, galactorrhea ceased in 90%, headaches resolved in 80%, and serum prolactin levels were restored to normal in 66%. Eight females and three males had Rathke's cleft cysts (mean age 34.0 years): of these 11 patients, 91% had headaches and 18% had hyperprolactinemia; of the eight females, 63% had amenorrhea and 63% had galactorrhea. Within these groups, serum prolactin levels normalized in 50%, and 80% noted reduced headache. Of the females, 80% had return of menses and 50% noted cessation of galactorrhea. Six males and two females had arachnoid cysts (mean age 42.2 years): 50% had headaches; 50% were asymptomatic. Preoperatively, 50% of these patients had hypothyroidism and 25% had adrenal hypofunction. Postoperatively, 75% of patients with headache noted improvement, and 33% of patients with abnormal thyroid function had normal function. Adrenal function did not improve. Three patients had an intrasellar cysticercosis cyst, epidermoid cyst, and postoperative cyst, respectively. All had evidence of partial hypopituitarism; none improved postoperatively. The results indicate that different types of pituitary cysts produce different clinical syndromes, and suggest that simple transsphenoidal drainage and partial removal of the cyst wall can provide safe and effective therapy.

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Epithelial cystic lesions of the sellar and parasellar region: a continuum of ectodermal derivatives?

Journal of Neurosurgery ◽

10.3171/jns.1994.80.6.1018 ◽

1994 ◽

Vol 80 (6) ◽

pp. 1018-1025 ◽

Cited By ~ 102

Author(s):

Michael J. Harrison ◽

Susan Morgello ◽

Kalmon D. Post

Keyword(s):

Clinical Presentation ◽

Cystic Lesions ◽

Content Type ◽

Epidermoid Cysts ◽

Parasellar Region ◽

Histological Criteria ◽

Rathke's Cleft Cysts ◽

Rathke's Cleft ◽

Epithelial Lesions ◽

Fine Print

✓ Cystic epithelial lesions of the sellar and parasellar region are classified on the basis of histology and location into Rathke's cleft cysts, epithelial cysts, epidermoid cysts, dermoid cysts, and craniopharyngiomas. A retrospective review of the clinical presentation, radiological findings, and histology was performed on 19 such lesions, and a survey of the literature pertinent to the classification, clinical presentation, and embryology of these lesions was conducted. Presentation was nonspecific and not predictive of histology. Imaging studies were generally useful in distinguishing these tumors, with the exception of Rathke's cleft cysts, suprasellar epidermoid cysts, and craniopharyngiomas, which frequently could not be differentiated. On microscopic examination, most lesions fit into distinct categories; however, overlap was common among all and some could not be definitively categorized by histological criteria. Evidence supportive of an ectodermal ancestry for sellar and parasellar epithelial-lined cystic lesions is presented. Based on the current findings and a review of the literature, it is suggested that these lesions represent a continuum of ectodermally derived cystic epithelial lesions.

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