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Neurosurgery. 2012 Jun;70(2 Suppl Operative):250-6; discussion 256-7. doi: 10.1227/NEU.0b013e3182418034.

Optimal surgical approaches for Rathke cleft cyst with consideration of endocrine function.

Author information

1
Endocrinology, Yonsei Brain Research Institute, Seoul, Korea.

Abstract

BACKGROUND:

Surgical indications for Rathke cleft cyst are not clear.

OBJECTIVE:

To evaluate postoperative outcomes in terms of endocrine function.

METHODS:

The study analyzed a total 73 patients who underwent transsphenoidal surgery. All patients underwent a visual field test, combined pituitary function test, and magnetic resonance imaging before and after surgery. A follow-up combined pituitary function test was performed at 1.5-year intervals.

RESULTS:

The mean age at the time of surgery was 35 ± 14 years, and the male/female ratio was 1:1.25 (33/40). The mean follow-up duration after surgery was 59 ± 39 months. The most common symptoms were headache (84%), visual disturbance (48%), and polyuria (38%). After transsphenoidal surgery, 75% of polyuria and 96% of visual field defects were resolved, and pituitary function improved in 42% of patients. The mean age of patients who exhibited worsened hypopituitarism was significantly higher than that of patients who exhibited unchanged or improved hypopituitarism (44 ± 15.7 vs 33 ± 13.5 years; P = .02). Twelve patients (16%) experienced recollection of cyst, but none required reoperation. Five of the recollected cysts presented with characteristics that were different from those of the initial lesions, and 2 recollected cysts underwent spontaneous regression.

CONCLUSION:

Minimal incision with radical removal of cyst content is reasonable to prevent the development of endocrine disturbances and other complications. Individualized risks and benefits must be assessed before a decision is reached regarding surgery and surgical method. Patients with recurrent Rathke cleft cyst require careful follow-up with special attention rather than a hasty operation.

PMID:
22089758
DOI:
10.1227/NEU.0b013e3182418034
[Indexed for MEDLINE]

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