Transsphenoidal Management of 28 Symptomatic Rathke's Cleft Cysts, with Special Reference to Visual and Hormonal Recovery

El-Mahdy, Wael; Powell, Michael

doi:10.1097/00006123-199801000-00003

Cited by 182 publications

(220 citation statements)

References 47 publications

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“…The low recovery rates are thought to be associated with an inflammatory process caused by the cyst contents, which may result in irreversible damage to the adjacent hypophysis. 7,8,12,25,33,43,54 Our results show that preoperative headache and visual dysfunction were resolved in 85% and 95% of patients, and both rates compare favorably with the findings of other studies. However, we achieved better resolution in the patients with hypopituitarism and DI than other series of similar sample size (55% and 65%, respectively).…”

Section: Outcome Analysissupporting

confidence: 89%

“…However, the range of recurrence rates in previous reports is quite large (0%-42%). 1,8,11,13,15,[23][24][25]28,[34][35][36]47,53 Several factors, including sample size, surgical modalities, duration of follow-up, and definitions of recurrence, may account for the variation. For example, the radiological recurrence rate in our series was 13%, while the symptomatic recurrence rate was 8%.…”

Section: Outcome Analysismentioning

confidence: 99%

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Individualized surgical strategies for Rathke cleft cyst based on cyst location

Fan¹,

Peng²,

Qi³

et al. 2013

JNS

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R athke cleft cysts (RCCs) are regarded as benign cystic lesions derived from a remnant of the Rathke pouch. They are common findings at autopsy, with a reported incidence of 5% to 33%, and account for 6%-10% of sellar lesions. 3,9,17,32,39,46,49 Although mostly asymptomatic, some RCCs can become sufficiently large to cause compressive effect on surrounding structures, resulting in neurological and endocrine disturbances. As a result, surgical intervention is recommended for symptomatic or at-risk patients.Traditionally, the 2 most common surgical approaches are the endonasal transsphenoidal route and the standard craniotomy. The endonasal approach is typically used for sellar lesions, whereas the craniotomy is indicated for suprasellar lesions. 2,11,38,40 Owing to its reduced invasiveness Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaObject. An assessment regarding both surgical approaches and the extent of resection for Rathke cleft cysts (RCCs) based on their locations has not been reported. The aim of this study was to report the results of a large series of surgically treated patients with RCCs and to evaluate the feasibility of individualized surgical strategies for different RCCs.Methods. We retrospectively reviewed 87 cases involving patients with RCCs (16 intrasellar, 50 intra-and suprasellar, and 21 purely suprasellar lesions). Forty-nine patients were treated via a transsphenoidal (TS) approach, and 38 were treated via a transcranial (TC) approach (traditional craniotomy in 21 cases and supraorbital keyhole craniotomy in 17). The extent of resection was classified as gross-total resection (GTR) or subtotal resection (STR) of the cyst wall. Patients were thus divided into 3 groups according to the approach selected and the extent of resection: TS/STR (n = 49), TC/STR (n = 23), and TC/GTR (n = 15).Results. Preoperative headaches, visual dysfunction, hypopituitarism, and diabetes insipidus (DI) resolved in 85%, 95%, 55%, and 65% of patients, respectively. These rates did not differ significantly among the 3 groups. Overall, complications occurred in 8% of patients in TS/STR group, 9% in TC/STR group, and 47% in TC/GTR group, respectively (p = 0.002). Cerebrospinal fluid (CSF) leakage (3%), new hypopituitarism (9%), and DI (6%) were observed after surgery. All CSF leaks occurred in the endonasal group, while the TC/GTR group showed a higher rate of postoperative hypopituitarism (p = 0.7 and p < 0.001, respectively). It should be particularly noted that preoperative hypopituitarism and DI returned to normal, respectively, in 100% and 83% of patients who underwent supraorbital surgery, and with the exception of 1 patient who had transient postoperative DI, there were no complications in patients treated with supraorbital surgery. Kaplan-Meier 3-year recurrence-free rates were 84%, 87%, and 86% in the TS/STR, TC/STR, and TC/GTR groups, respectively (p = 0.9).Conclusions. It is reasonable to adopt individualized surgical strategies for RCCs based on cyst location....

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Section: Outcome Analysissupporting

confidence: 89%

Section: Outcome Analysismentioning

confidence: 99%

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Fan¹,

Peng²,

Qi³

et al. 2013

JNS

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“…38,54 Rathke's cleft cysts are believed to be derived from true remnants of the embryological Rathke's pouch. 3,11,16,23 As regards the development of RCC, theoretically, during the 3rd or 4th week of gestation, a rostral outpouching of the ectodermal primitive oral cavity meets a downward projection from the neuroectodermal diencephalon. These structures then give rise to the anterior lobe, pars tuberalis, and pars intermedia of the pituitary gland.…”

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confidence: 99%

Characteristics of Rathke's cleft cyst based on cyst location with a primary focus on recurrence after resection

Chotai¹,

Liu²,

Qi³

2015

JNS

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Rathke's cleft cysts (RCCs) are nonneoplastic epithelial lesions of the sellar and suprasellar region. They are typically asymptomatic with a slow growth rate. An asymptomatic RCC is most often diagnosed at autopsy with a reported incidence of 5%-33%. 5,[47][48][49] Quite often some RCCs grow over time and can become sufficiently large to cause a compressive effect on surrounding structures, resulting in neurological and endocrine abnormalities. 7,28,37,42 Sixteen patients (18%) had an entirely intrasellar RCC, 21 (24%) had a purely suprasellar cyst, and 50 (58%) had an intrasuprasellar RCC. The mean cyst volume was 2.4 ± 0.9 cm 3 (range 0.36-4.9 cm 3 ). Headache was the most frequent initial symptom (76%) followed by visual disturbance (45%). The transsphenoidal approach was performed for all intrasellar RCCs (16 cysts) and 33 of 50 intrasuprasellar RCCs. The transcranial route was used for all suprasellar cysts (21 cysts) and 17 of 50 intrasuprasellar RCCs. Squamous metaplasia was present in 27 (31%) of 87 RCCs. The occurrence of squamous metaplasia was associated with cyst location (p = 0.027), T1 signal intensity (p = 0.004) and ring enhancement on Gd-enhanced MRI (p = 0.017), and cyst volume (p = 0.045). A suprasellar location (p = 0.048, OR 3.89, 95% CI 1.010-15.020), ring enhancement on Gd-enhanced MRI (p = 0.028, OR 3.922, 95% CI 1.158-13.288), hypointensity on T1-weighted MRI (p = 0.002, OR 6.86, 95% CI 1.972-23.909), and cyst volume (p = 0.01, OR 0.367, 95% CI 0.170-0.789) were independent predictors of squamous metaplasia. The mean time to reaccumulation (11 [12.6%] of 87 cases) and recurrence (7 [8%] of 87 cases) was 14 ± 6 months. Recurrence-free survival was 84.5% at a mean of 98.2 ± 4.6 months after treatment. A suprasellar cyst location (p = 0.007, OR 7.7, 95% CI 1.75-34.54), the occurrence of squamous metaplasia (p = 0.007, OR 19.3,, and isointensity on T2-weighted MRI (p = 0.041, OR 10.29, 95% CI 1.094-96.872) were the independent predictors of RCC recurrence. coNclusioNs A suprasellar cyst location, the occurrence of squamous metaplasia, and isointensity on T2-weighted MRI were independent predictors of RCC recurrence. The extent of resection and type of surgical approach used were not associated with recurrence. A tailored extent of resection based on cyst location and predictive factors is recommended.

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“…Em adultos, observa-se amenorréia, paresia espástica discreta em membros inferiores, cefaléia, deficiência visual quiasmática e confusão mental (1)(2)13) . Alguns autores (14) concluíram de 28 casos estudados de cistos da fenda de Rathke, 50% apresentaram distúrbios endó-crinos, 32,1% cefaléia e 14,3% distúrbios visuais. Autores (5) , estudando 12 pacientes com cisto da fenda de Rathke, constataram cefaléia em 91% dos pacientes, hiperprolactinemia em 18% e amenorréia em 63%.…”

Section: Discussionunclassified

“…Algumas característi-cas são úteis para distinguir a imagem dos cistos da fenda de Rathke dos craniofaringiomas, como o tamanho do cisto, a idade do paciente, já que a maior incidência dos craniofaringiomas ocorre em pacientes com idade abaixo de 20 anos e os cistos da fenda de Rathke são mais freqüentes em adultos, e a presença ou não de captação na parede do cisto (13) . As imagens radiológicas características de cisto da fenda de Rathke são de uma lesão com epicentro selar, de contornos lisos, ausência de calcificações e de realces internos e apresentação homogênea à RM (14) . Alguns autores relataram que foram incapazes de identificar qualquer achado característico nas imagens de TC ou de RM que pudessem diferenciar os cistos da fenda de Rathke de outras lesões, como o faringioma e os cistos adenomas hipofisários (2,8,15) .…”

Section: Discussionunclassified

Alterações visuais decorrentes do cisto da fenda de Rathke: relato de caso

Rech¹,

Prochnau²,

Rosa³

et al. 2004

Arq. Bras. Oftalmol.

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Os cistos da fenda de Rathke são lesões para-selares, geralmente assintomáticas, presentes em 12 a 33% das autópsias de pacientes com hipófise normal. Ocasionalmente, os cistos podem aumentar de volume a ponto de comprimir estruturas supra-selares e intra-selares, levando ao aparecimento dos sintomas. Clinicamente, os pacientes referem escurecimento visual, além de apresentarem defeitos campimétricos. M.A.S.R., 47 anos, sexo feminino, branca, natural de Pelotas/RS com queixa de embaçamento progressivo da visão do olho direito há 2 meses. Ao exame, constatou-se baixa visual e hemianopsia bitemporal. A tomografia computadorizada evidenciou imagem hipodensa arredondada, de bordos nítidos, em topografia selar, determinando remodelação e alargamento da sela túrcica. A ressonância magnética mostrou lesão expansiva cística localizada na sela túrcica com crescimento supra-selar. A referida lesão apresenta obliteração da cisterna supra-selar e importante compressão sobre o quiasma óptico. A abordagem cirúrgica confirmou a presença de lesão expansiva cística comprimindo o quiasma óptico e o exame de anatomia patológica do material diagnosticou cisto da fenda de Rathke. O exame oftalmológico, três meses após a cirurgia, mostrou melhora da acuidade visual e recuperação total dos defeitos do campo visual. O cisto da fenda de Rathke deve ser incluído no diagnóstico diferencial dos tumores para-selares passíveis de causar compressão da via óptica nervosa e ressalta-se a importância do diagnóstico e tratamento precoce no intuito de prevenir danos estruturais com perdas irreversíveis da função visual, bem como os distúrbios endócrinos.

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Transsphenoidal Management of 28 Symptomatic Rathke's Cleft Cysts, with Special Reference to Visual and Hormonal Recovery

Cited by 182 publications

References 47 publications

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Characteristics of Rathke's cleft cyst based on cyst location with a primary focus on recurrence after resection

Alterações visuais decorrentes do cisto da fenda de Rathke: relato de caso

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