Surgery for Rathke cleft cysts

Technical considerations and outcomes

Ronald Benveniste, Wesley A. King, Jane Walsh, Jacob S. Lee, Thomas P. Naidich, Kalmon D. Post

Research output: Contribution to journalArticle

97 Citations (Scopus)

Abstract

Object. The aim of this study was to identify the optimal surgical goals and techniques for managing symptomatic Rathke cleft cysts (RCCs). Methods. The authors conducted a retrospective study of 62 consecutive patients who had undergone surgery for RCCs. Postoperative follow up was a mean of 28 months. Fifty-six patients underwent transsphenoidal cyst decompression and biopsy procedures, and six underwent cyst wall resection. Postoperatively, symptoms improved in 91% of patients with headaches and 92% of patients with visual deficits. Decompression and biopsy were associated with a 10% incidence of new anterior pituitary hormone deficiencies and a 6% incidence of new permanent diabetes insipidus; the incidence of new hormone deficiencies was significantly higher in the few patients who had undergone cyst wall resection. The incidence of relapse, defined as cyst regrowth with either recurrent symptoms or chiasmal compression, was 16%. Resection of the cyst wall was associated with a trend toward a decreased risk of relapse. Sellar packing, sellar floor reconstruction, and irrigation with absolute ethanol did not affect the likelihood of relapse. Squamous metaplasia and inflammation increased the risk of relapse. Residual cyst demonstrated on postoperative magnetic resonance imaging was associated with an increased risk of subsequent asymptomatic cyst regrowth. Seven patients (11%) underwent repeated operation with symptomatic improvement and minimal morbidity; only one patient relapsed following a second surgery. Conclusions. Decompression and biopsy procedures in the treatment of RCCs lead to improvement in signs and symptoms, with low morbidity rates. Repeated operations will be required in as many as 16% of patients but are also associated with symptomatic improvement, low morbidity, and durable remission. Decompression and biopsy may represent the optimal surgical management of RCC.

Original languageEnglish
Pages (from-to)577-584
Number of pages8
JournalJournal of Neurosurgery
Volume101
Issue number4
DOIs
StatePublished - Oct 1 2004
Externally publishedYes

Fingerprint

Central Nervous System Cysts
Cysts
Decompression
Biopsy
Recurrence
Incidence
Morbidity
Anterior Pituitary Hormones
Diabetes Insipidus
Metaplasia
Signs and Symptoms
Headache
Ethanol
Retrospective Studies
Magnetic Resonance Imaging
Hormones
Inflammation

Keywords

  • Disease recurrence
  • Pituitary
  • Rathke cleft cyst
  • Repeated surgery
  • Transsphenoidal surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Surgery for Rathke cleft cysts : Technical considerations and outcomes. / Benveniste, Ronald; King, Wesley A.; Walsh, Jane; Lee, Jacob S.; Naidich, Thomas P.; Post, Kalmon D.

In: Journal of Neurosurgery, Vol. 101, No. 4, 01.10.2004, p. 577-584.

Research output: Contribution to journalArticle

Benveniste, Ronald ; King, Wesley A. ; Walsh, Jane ; Lee, Jacob S. ; Naidich, Thomas P. ; Post, Kalmon D. / Surgery for Rathke cleft cysts : Technical considerations and outcomes. In: Journal of Neurosurgery. 2004 ; Vol. 101, No. 4. pp. 577-584.
@article{e421c62e467643b6a1f9284dae7f672f,
title = "Surgery for Rathke cleft cysts: Technical considerations and outcomes",
abstract = "Object. The aim of this study was to identify the optimal surgical goals and techniques for managing symptomatic Rathke cleft cysts (RCCs). Methods. The authors conducted a retrospective study of 62 consecutive patients who had undergone surgery for RCCs. Postoperative follow up was a mean of 28 months. Fifty-six patients underwent transsphenoidal cyst decompression and biopsy procedures, and six underwent cyst wall resection. Postoperatively, symptoms improved in 91{\%} of patients with headaches and 92{\%} of patients with visual deficits. Decompression and biopsy were associated with a 10{\%} incidence of new anterior pituitary hormone deficiencies and a 6{\%} incidence of new permanent diabetes insipidus; the incidence of new hormone deficiencies was significantly higher in the few patients who had undergone cyst wall resection. The incidence of relapse, defined as cyst regrowth with either recurrent symptoms or chiasmal compression, was 16{\%}. Resection of the cyst wall was associated with a trend toward a decreased risk of relapse. Sellar packing, sellar floor reconstruction, and irrigation with absolute ethanol did not affect the likelihood of relapse. Squamous metaplasia and inflammation increased the risk of relapse. Residual cyst demonstrated on postoperative magnetic resonance imaging was associated with an increased risk of subsequent asymptomatic cyst regrowth. Seven patients (11{\%}) underwent repeated operation with symptomatic improvement and minimal morbidity; only one patient relapsed following a second surgery. Conclusions. Decompression and biopsy procedures in the treatment of RCCs lead to improvement in signs and symptoms, with low morbidity rates. Repeated operations will be required in as many as 16{\%} of patients but are also associated with symptomatic improvement, low morbidity, and durable remission. Decompression and biopsy may represent the optimal surgical management of RCC.",
keywords = "Disease recurrence, Pituitary, Rathke cleft cyst, Repeated surgery, Transsphenoidal surgery",
author = "Ronald Benveniste and King, {Wesley A.} and Jane Walsh and Lee, {Jacob S.} and Naidich, {Thomas P.} and Post, {Kalmon D.}",
year = "2004",
month = "10",
day = "1",
doi = "10.3171/jns.2004.101.4.0577",
language = "English",
volume = "101",
pages = "577--584",
journal = "Journal of Neurosurgery",
issn = "0022-3085",
publisher = "American Association of Neurological Surgeons",
number = "4",

}

TY - JOUR

T1 - Surgery for Rathke cleft cysts

T2 - Technical considerations and outcomes

AU - Benveniste, Ronald

AU - King, Wesley A.

AU - Walsh, Jane

AU - Lee, Jacob S.

AU - Naidich, Thomas P.

AU - Post, Kalmon D.

PY - 2004/10/1

Y1 - 2004/10/1

N2 - Object. The aim of this study was to identify the optimal surgical goals and techniques for managing symptomatic Rathke cleft cysts (RCCs). Methods. The authors conducted a retrospective study of 62 consecutive patients who had undergone surgery for RCCs. Postoperative follow up was a mean of 28 months. Fifty-six patients underwent transsphenoidal cyst decompression and biopsy procedures, and six underwent cyst wall resection. Postoperatively, symptoms improved in 91% of patients with headaches and 92% of patients with visual deficits. Decompression and biopsy were associated with a 10% incidence of new anterior pituitary hormone deficiencies and a 6% incidence of new permanent diabetes insipidus; the incidence of new hormone deficiencies was significantly higher in the few patients who had undergone cyst wall resection. The incidence of relapse, defined as cyst regrowth with either recurrent symptoms or chiasmal compression, was 16%. Resection of the cyst wall was associated with a trend toward a decreased risk of relapse. Sellar packing, sellar floor reconstruction, and irrigation with absolute ethanol did not affect the likelihood of relapse. Squamous metaplasia and inflammation increased the risk of relapse. Residual cyst demonstrated on postoperative magnetic resonance imaging was associated with an increased risk of subsequent asymptomatic cyst regrowth. Seven patients (11%) underwent repeated operation with symptomatic improvement and minimal morbidity; only one patient relapsed following a second surgery. Conclusions. Decompression and biopsy procedures in the treatment of RCCs lead to improvement in signs and symptoms, with low morbidity rates. Repeated operations will be required in as many as 16% of patients but are also associated with symptomatic improvement, low morbidity, and durable remission. Decompression and biopsy may represent the optimal surgical management of RCC.

AB - Object. The aim of this study was to identify the optimal surgical goals and techniques for managing symptomatic Rathke cleft cysts (RCCs). Methods. The authors conducted a retrospective study of 62 consecutive patients who had undergone surgery for RCCs. Postoperative follow up was a mean of 28 months. Fifty-six patients underwent transsphenoidal cyst decompression and biopsy procedures, and six underwent cyst wall resection. Postoperatively, symptoms improved in 91% of patients with headaches and 92% of patients with visual deficits. Decompression and biopsy were associated with a 10% incidence of new anterior pituitary hormone deficiencies and a 6% incidence of new permanent diabetes insipidus; the incidence of new hormone deficiencies was significantly higher in the few patients who had undergone cyst wall resection. The incidence of relapse, defined as cyst regrowth with either recurrent symptoms or chiasmal compression, was 16%. Resection of the cyst wall was associated with a trend toward a decreased risk of relapse. Sellar packing, sellar floor reconstruction, and irrigation with absolute ethanol did not affect the likelihood of relapse. Squamous metaplasia and inflammation increased the risk of relapse. Residual cyst demonstrated on postoperative magnetic resonance imaging was associated with an increased risk of subsequent asymptomatic cyst regrowth. Seven patients (11%) underwent repeated operation with symptomatic improvement and minimal morbidity; only one patient relapsed following a second surgery. Conclusions. Decompression and biopsy procedures in the treatment of RCCs lead to improvement in signs and symptoms, with low morbidity rates. Repeated operations will be required in as many as 16% of patients but are also associated with symptomatic improvement, low morbidity, and durable remission. Decompression and biopsy may represent the optimal surgical management of RCC.

KW - Disease recurrence

KW - Pituitary

KW - Rathke cleft cyst

KW - Repeated surgery

KW - Transsphenoidal surgery

UR - http://www.scopus.com/inward/record.url?scp=7944228330&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=7944228330&partnerID=8YFLogxK

U2 - 10.3171/jns.2004.101.4.0577

DO - 10.3171/jns.2004.101.4.0577

M3 - Article

VL - 101

SP - 577

EP - 584

JO - Journal of Neurosurgery

JF - Journal of Neurosurgery

SN - 0022-3085

IS - 4

ER -