Rathke’s Cleft Cyst
Endoscopic endonasal surgery is the preferred approach for symptomatic Rathke’s Cleft Cysts
Rathke’s Cleft Cyst are fluid-filled masses arising within or above the pituitary gland & may cause loss of hormonal function, visual loss and/or headaches.
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. However, for patients with a symptomatic (and typically larger) Rathke’s cleft cyst, endoscopic endonasal surgical removal (via the nose) is the treatment of choice. Fortunately, there have been major technical advances in this surgical approach over the last two decades, including use of high-definition endoscopy, surgical navigation techniques and more effective skull base closure methods. See our recent publication on Rathke’s Cleft Cysts.
At Pacific Pituitary Disorders Program, we have one of the world’s largest experiences in transsphenoidal endoscopic endonasal surgery. By incorporating cutting edge technology and instrumentation with proven surgical experience of over 1600 endonasal surgeries, we make Rathke’s Cleft Cyst surgery safer, less invasive and more effective. Dr. Kelly and his team also have a large surgical experience treating patients who have had prior surgery for a RCC.
Rathke’s Cleft Cysts are not true tumors or neoplasms; instead they are benign cysts. Rathke’s pouch forms as part of normal development and 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. RCCs can cause pituitary failure, headaches and in some instances, vision loss.
Symptomatic RCCs are relatively common pituitary lesions, accounting for 5-10% of surgically removed pituitary masses. RCCs can be seen at any age, although most are identified in adults. However, many intrasellar RCCs 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. These smaller RCCs rarely need treatment and can be simply “followed” with regular MRIs every year or so. However, larger RCCs (typically > 1 cm in maximal diameter) may cause visual disturbances, symptoms of Pituitary Dysfunction, and headaches and do often require surgical removal.
The typical means of visualizing a RCC 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 surgery is the standard treatment for symptomatic RCCs causing pituitary failure, headache or visual loss. Typically, this requires surgical removal through an Endoscopic Endonasal Surgery. 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 RCCs is possible in 80-95% of cases although they can recur at a rate of 5 – 15% over 5 to 10 years.