Clinical study of symptomatic Rathke cleft cyst

The clinical, radiographic findings in 12 patients with symptomatic Rathke cleft cysts (RCC) are presented. The mean age of these patients was 52 years, and 9 of the patients were female. Visual disturbance was the most common symptom, followed by headache. Magnetic resonance images (MRIs) were reviewed in 11 cases. In two cases, the cyst fluid had low signal intensity on T1-weighted images and high intensity on T2-weighted images. In eight cases the cyst fluid had iso-to-high intensity on both T1 and T2-weighted images. On dynamic MRI study using Gd-DTPA, normal anterior pituitary gland was seen superior to the RCC in 4 cases, anterior in 4, and inferior in 2 cases. In accordance with the MRI findings, transcranial approach was chosen in 4 cases and the transsphenoidal route was used in eight cases. Most symptoms and signs improved or resolved following surgery with the exception of those cases with a longstanding history of hypopituitarism. We experienced two cases of recurrence at 7 months, and 65 months respectively requiring a second operation, and the mean follow-up period for all cases was 78 months. Differential diagnosis between RCC and craniopharyngioma should be carefully made in the recurrent cases by surgical specimens of the cyst wall. Partial resection of the cyst wall and drainage of the contents via the transsphenoidal route is a safe and effective procedure in the majority of cases, but the transcranial approach is the treatment of choice in cases in which the cyst is entirely located in the suprasellar region.