Surgical management of Rathke's cleft cysts

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Abstract

Purpose of review

Rathke's cleft cysts arise from embryonic remnants of Rathke's cleft. The purpose of this paper is to review the current knowledge pertaining to Rathke's cleft cysts. Recent studies regarding the management of Rathke's cleft cysts are also discussed.

Recent findings

Rathke's cleft cysts generally exhibit a benign clinical course. Magnetic resonance imaging is the diagnostic imaging study of choice. Although the most consistent sign to differentiate Rathke's cleft cysts is the lack of enhancement of the cyst wall on contrast-enhanced magnetic resonance images, the presence of an intracystic nodule of low signal intensity on T2-weighted images and possibly high signal intensity on T1-weighted images is highly characteristic of Rathke's cleft cysts. Surgical management is the treatment for symptomatic Rathke's cleft cysts, although asymptomatic lesions may be followed conservatively. Drainage of the cyst contents is the primary goal of surgery; aggressive total resection of the cyst wall, however, may be associated with greater endocrine morbidity. Recurrence may be more common than previously noted when a longer follow-up period is observed.

Summary

Incidental Rathke's cleft cysts may be followed with serial imaging. Symptomatic Rathke's cleft cysts are best removed via the transsphenoidal route. Extended postoperative follow-up is indicated in all patients.

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