Rathke’s Cleft Cyst

What is Rathke’s Cleft Cyst?

Overview

Rathke’s cleft cysts (RCC) are not true tumors or neoplasms; instead they are benign developmental cysts.

Rathke’s cleft cysts, a remarkable anomaly originating from embryonic tissue remnants, emerge deep within the recesses of the pituitary gland. Formed during the early stages of development, the cyst emerges from the Rathke’s pouch—a critical structure responsible for the formation of the pituitary gland. Rathke’s pouch eventually forms the anterior lobe, pars intermedia and pars tuberalis, of the pituitary gland. This pouch normally closes in fetal development, but a remnant often persists as a cleft that lies between the anterior and posterior lobes of the pituitary gland. Occasionally, this remnant enlarges to form a cyst.

Rathke’s cleft cysts are fluid-filled masses arising within or above the pituitary gland and may cause loss of hormonal function, headaches, and in some instances, vision loss.

It’s important to note that RCC is classified as a noncancerous (benign) developmental cyst, making it distinct from other pituitary tumors. While the cyst’s presence may not be immediately apparent, it can significantly impact hormone production and lead to various pituitary gland dysfunctions.

Who is Affected?

Symptomatic Rathke’s cleft cysts are relatively common pituitary lesions, accounting for 5-10% of surgically removed pituitary masses. Rathke cleft cysts can be seen at any age, although most are identified in adults. However, many intrasellar Rathke’s cleft cysts that are within the pituitary gland may be quite small, are usually asymptomatic and are found incidentally at autopsy or on a magnetic resonance imaging (MRI) scan.

Rathke’s Cleft Cyst Symptoms & Causes

Symptoms

Unraveling the mysteries of Rathke’s cleft cyst requires awareness of its associated symptoms.

Individuals with Rathke’s cleft cyst may experience a range of manifestations, including:

• Debilitating headaches
• Changes in vision
• Disruptions in hormonal balance
• Pituitary gland dysfunction

Causes

Rathke’s cleft cysts are developmental anomalies resulting from incomplete closure of Rathke’s pouch during fetal development. They are not caused by tumors, infections, or injuries.

When to See a Doctor

Contact our clinics and seek medical evaluation if you experience:

• Frequent or worsening headaches
• Changes in vision (blurriness, double vision, or loss of peripheral vision)
• Symptoms of hormone imbalance (e.g., fatigue, weight changes, irregular periods)
• Sudden severe headache or vision changes, which may indicate a ruptured cyst

Rathke’s Cleft Cyst Diagnosis

Prompt diagnosis is crucial, involving a comprehensive approach that combines meticulous physical examinations, advanced imaging studies such as magnetic resonance imaging (MRI) and computed tomography (CT) scans, as well as hormone level tests.

The typical means of visualizing a Rathke’s cleft cysts is with an MRI or a computer tomography (CT) scan of the pituitary region performed without and with contrast. A complete pituitary hormonal blood evaluation should also be performed.

Other possible diagnoses to consider when a cystic mass is seen in the area of the pituitary include a cystic pituitary adenoma, craniopharyngioma or arachnoid cyst.

Rathke’s Cleft Cyst Treatment & Outcomes

Treatment Options

Observation: Over half of all Rathke’s cleft cysts seen in our practice are incidental findings, cause no symptoms or hormonal problems, and require no treatment. They can be simply “followed” with regular MRIs every year or so.

Surgery: However, for patients with a symptomatic Rathke’s cleft cyst (typically larger being greater than 1 cm in maximal diameter), endoscopic endonasal surgical removal (via the nose) is the treatment of choice. The goal of surgery is to completely remove the cyst contents while improving or preserving pituitary function vision and alleviating headache and visual loss if present. Attempts to remove the cyst lining should be avoided because this can result in pituitary gland damage. A complete removal of Rathke’s cleft cysts is possible in 80-95% of cases although they can recur at a rate of 5 – 15% over 5 to 10 years.

Fortunately, there have been major technical advances in this surgical approach, including use of high-definition endoscopy, surgical navigation techniques and more effective skull base closure methods.

Patient Outcomes

Most patients experience significant improvement in headaches, vision, and hormonal function after surgery.

• Recovery: Most patients are out of bed and eating the day after surgery, with hospital discharge typically within 1–2 days.
• Recurrence: The recurrence rate is low (1% per year), but long-term follow-up with MRI scans is recommended.

Managing Rathke’s Cleft Cyst

Even after surgery, ongoing follow-up is important. This may include:

Meet our Expert Specialists & Surgeons

At the Pacific Pituitary Disorder Center our doctors and specialists have years of experience treating Rathke’s cleft cyst and other pituitary disorders that are complex in their diagnosis and treatment, and warrant a team approach of experienced specialists to achieve optimal outcomes. From diagnosis to treatment, as well as education and support, we are here for you.

Abbas A. Anwar, MD

ENT Surgery, Neurorhinology

Garni Barkhoudarian, MD

Neurosurgery

Walavan Sivakumar, MD

Neurosurgery

Chester F. Griffiths, MD

ENT Surgery

Daniel F. Kelly, MD

Neurosurgery

Noa Tal, MD

Endocrinology

Michael Yong, MD, MPH, MBA

ENT Surgery, Neuro-rhinology

Alexander M. Solomon, MD

Neuro-ophthalmology

Howard R. Krauss, MD

Neuro-ophthalmology

Experience Compassionate, Expert Care

At Pacific Neuroscience Institute, our multidisciplinary team of neurosurgeons, endocrinologists, and specialists collaborate to provide a thorough evaluation, ensuring accurate diagnosis and tailored treatment plans. At the Pacific Pituitary Disorders Center, we have one of the world’s largest experiences in transsphenoidal endoscopic endonasal surgery. By incorporating leading-edge technology and instrumentation with proven surgical experience of over 2000 endonasal surgeries, we make Rathke’s cleft cyst surgery safer, less invasive and more effective. We also have a large surgical experience treating patients who have had prior surgery for a RCC.

Learn More About Rathke’s Cleft Cyst

Resources