Diagnosis and treatment of Rathke's cleft cysts

Objective:To raise the diagnos and treatment level of Rathke′s cleft cysts.Methods:We retrospectively reviewed data collected on Rathke′s cleft cysts between 1993 and 2002, 33 patients presenting symptoms were treated by transsphenoidal surgery. Before the operation, headache was present in 78.8%, pituitary dysfunction in 62.4% and visual interference in 27.3%,enlargement of the sella turcica on plain x-rays in 15.2%. CT showed high density lesion in 61.5%,and MRI showed high intensity on T1 weighted images lesion in 63.6%,iso-intensity in 15.2%, low intensity in 12.1%,and others in 9.1% and no enhancement in all of cases. All patients were treated by a transsphenoidal surgery.Results: Postoperative visual disturbance improved in 100% of patients,headaches were resolved in 84.6%,Amenorrhea recovered or improved in 72.7%.Conclusions: Results of the present study indicate: 1)The incidence of pituitary dysfunction in patients with Rathke′s cleft cyst is higher than suspected.2).When a non-enhancing cyst-like structure in the sella turcica with CT showed high density and MRI showed high intensity or low intensity on T1 is demonstrated,the possibility of Rathke′s cleft cyst should be considered.3).Most Rathke cleft cysts can be treated by a transsphenoidal surgery and in most cases surgical intervention improves pituitary function and the clinical status of the patient.4).Surgical treatment is recommended even when the patient has only mild symptoms or signs, including pituitary dysfunction, to prevent irreversible panhypopituitarism.