Peer-Review Report: Symptomatic Rathke Cleft Cyst: Clinical Features and Surgical Outcomes

Abstract

Objective

To depict the clinical, operative, and histological features of Rathke cleft cysts (RCCs) in consideration of therapeutic results and recurrence rates.

Methods

This study included 40 patients (29 female; mean age, 41 years) of symptomatic RCCs with pathological verification. The mean length of follow-up was 76 months. The patients were treated by complete cyst evacuation combined with partial wall excision (7 via craniotomy and 33 transsphenoidally). All subjects were examined neurologically, radiologically, and biochemically to ascertain the clinical significance of surgery on endocrine and visual improvement.

Results

Cysts varied in size from 18 to 43 mm (mean, 19.3 mm); 38 (95.0%) had a suprasellar component. Presenting symptoms included headache (75.0%), chiasmopathy (45.0%), and endocrine dysfunction (37.5%). On magnetic resonance imaging, the signal intensities of the cysts were quite variable, with most commonly hyperintensity (75.0%) on T2-weighted and hypointensity (40.0%) on T1-weighted scans, respectively. Cyst contents were found to be mostly mucoid (52.5%) and watery (30.0%). Squamous epithelium was identified in 18 specimens (45.0%). Headaches and visual symptoms resolved or improved in 76.7% and 78.6% of patients, respectively. Hypothyroidism, hypogonadism, growth hormone deficiency, and hypocortisolemia was resolved in 44.4%, 30.0%, 33.3%, and 56.3% of patients, respectively. Two patients (5%) had repeat surgery for symptomatic relapse. Cerebrospinal fluid leakage (2.5%), new hormone deficit (7.5%), and diabetes insipidus (5.0%) were observed after surgery.

Conclusions

When RCCs are recognized intraoperatively, the evacuation of their contents and partial cyst obliteration generally afford dramatic improvements in a patient's clinical signs and symptoms, along with low complications and rate of recurrence.

Key words Chiasmopathy; Headache; Pituitary endocrine dysfunction; Rathke cleft cyst; Transsphenoidal surgery