TY - JOUR
T1 - Recurrent Rathke's Cleft cysts
T2 - Incidence and surgical management in a tertiary pituitary center over 2 decades
AU - Wedemeyer, Michelle A.
AU - Lin, Michelle
AU - Fredrickson, Vance L.
AU - Arakelyan, Anush
AU - Bradley, Daniel
AU - Donoho, Daniel A.
AU - Hurth, Kyle M.
AU - Weiss, Martin H.
AU - Carmichael, John D.
AU - Zada, Gabriel
N1 - Publisher Copyright:
© 2018 by the Congress of Neurological Surgeons.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - BACKGROUND: Limited data exist pertaining to outcomes following surgery for recurrent Rathke's cleft cysts (RCC). OBJECTIVE: To determine treatment outcomes in patients undergoing reoperation for recurrent or residual RCCs. METHODS: A retrospective analysis of 112 consecutive RCC operations in 109 patients between 1995 and 2017 was conducted. RESULTS: Eighteen patients underwent 21 RCC reoperations with a mean follow-up of 58 mo. Patient symptoms prior to reoperation included headaches (14, 66.7%) and vision loss (12, 57.1%). Thirteen of 18 patients (72.2%) required hormone supplementation prior to reoperation including 5 with diabetes insipidus (DI). Mean RCC diameter was 16 mm and 76% had suprasellar extension. Compared to index RCC cases, intraoperative cerebrospinal fluid leak repair was more common in reoperation cases (15/21, 71% vs 43/91, 47%, P = .05). There was 1 carotid artery injury without neurological sequelae, and 2 postoperative cerebrospinal fluid (CSF) leaks (9.5%). Rates of transient hyponatremia (3/10, 30% vs 4/91, 4.4%, P=.04) and transient DI (5/10, 50% vs 17/91, 18.7%, P=.04) were higher in the reoperation vs index group. Improved headaches and vision were reported in 4/12 (33%) and 8/12 (61.5%) of RCC reoperation patients, respectively. Two patients developed new permanent DI. A higher proportion of reoperation patients had RCC squamous metaplasia (24% vs 5.4%, P = .02) or wall inflammation (42.9% vs 2.2%, P < .001) on pathological examination. CONCLUSION: Reoperation for RCCs is generally safe at tertiary pituitary centers and often results in improved vision. Hypopituitarism is less likely to improve following reoperation for recurrent RCCs. Several histopathological featuresmay help characterize "atypical RCCs" with a higher likelihood of recurrence/progression.
AB - BACKGROUND: Limited data exist pertaining to outcomes following surgery for recurrent Rathke's cleft cysts (RCC). OBJECTIVE: To determine treatment outcomes in patients undergoing reoperation for recurrent or residual RCCs. METHODS: A retrospective analysis of 112 consecutive RCC operations in 109 patients between 1995 and 2017 was conducted. RESULTS: Eighteen patients underwent 21 RCC reoperations with a mean follow-up of 58 mo. Patient symptoms prior to reoperation included headaches (14, 66.7%) and vision loss (12, 57.1%). Thirteen of 18 patients (72.2%) required hormone supplementation prior to reoperation including 5 with diabetes insipidus (DI). Mean RCC diameter was 16 mm and 76% had suprasellar extension. Compared to index RCC cases, intraoperative cerebrospinal fluid leak repair was more common in reoperation cases (15/21, 71% vs 43/91, 47%, P = .05). There was 1 carotid artery injury without neurological sequelae, and 2 postoperative cerebrospinal fluid (CSF) leaks (9.5%). Rates of transient hyponatremia (3/10, 30% vs 4/91, 4.4%, P=.04) and transient DI (5/10, 50% vs 17/91, 18.7%, P=.04) were higher in the reoperation vs index group. Improved headaches and vision were reported in 4/12 (33%) and 8/12 (61.5%) of RCC reoperation patients, respectively. Two patients developed new permanent DI. A higher proportion of reoperation patients had RCC squamous metaplasia (24% vs 5.4%, P = .02) or wall inflammation (42.9% vs 2.2%, P < .001) on pathological examination. CONCLUSION: Reoperation for RCCs is generally safe at tertiary pituitary centers and often results in improved vision. Hypopituitarism is less likely to improve following reoperation for recurrent RCCs. Several histopathological featuresmay help characterize "atypical RCCs" with a higher likelihood of recurrence/progression.
KW - Complications
KW - Endoscopic endonasal approach
KW - Microsurgery
KW - Rathke's cleft cyst
KW - Recurrence
KW - Transsphenoidal
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U2 - 10.1093/ons/opy258
DO - 10.1093/ons/opy258
M3 - Article
C2 - 30247673
AN - SCOPUS:85065228728
SN - 2332-4252
VL - 16
SP - 675
EP - 684
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 6
ER -