Rathke’s cleft cysts following transsphenoidal surgery: long-term outcomes and development of an optimal follow-up strategy

• Published in: Acta neurochirurgica Vol. 162; no. 4; pp. 853 - 861
• Main Authors: Marcus, Hani J., Borg, Anouk, Hussein, Ziad, Jaunmuktane, Zane, Baldeweg, Stephanie E., Grieve, Joan, Dorward, Neil L.
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.04.2020; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Brain Neoplasms - complications; Brain Neoplasms - surgery; Central Nervous System Cysts - complications; Central Nervous System Cysts - surgery; Cysts; Disease Progression; Female; Follow-Up Studies; Humans; Interventional Radiology; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Neoplasm Recurrence, Local - surgery; Neoplasm, Residual - surgery; Neurology; Neuroradiology; Neurosurgery; Neurosurgical Procedures; Original - Pituitaries; Original Article - Pituitaries; Patients; Pituitaries; Postoperative Period; Reoperation; Retrospective Studies; Surgery; Surgical Orthopedics; Treatment Outcome; Vision; Vision Disorders - etiology; Vision Disorders - surgery; Young Adult; Rathke’s cleft cyst; Surgery; Pituitary; Outcomes
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-020-04237-5

Background In patients with symptomatic Rathke’s cleft cyst, transsphenoidal surgery is highly effective at preventing further visual loss and usually allows for some recovery of vision. However, cyst recurrence and the need for re-operation are well recognized. To this end, the aim of this study was to investigate patterns of recurrence and long-term outcomes and to use this information to develop an optimal follow-up strategy. Method A prospectively maintained database was searched over a 10-year period between 1 January 2008 and the 1 January 2018 to identify all adults that underwent transsphenoidal surgery with a new diagnosis of Rathke’s cleft cyst. A retrospective case note review was performed for each patient to extract data on their presentation, investigation, treatment, and outcome. Results In all, 61 eligible patients were identified. The median follow-up was 34 months (range 2–112 months). In the 22 patients with pre-operative visual loss, the outcomes at 6 months were as follows: normal vision (2/22; 9.1%), improved but not normal (7/22; 31.8%), stable (12/22; 54.5%), worse but not blind (1/22; 4.5%), and blind (0/22; 0%). The overall rate of regrowth and re-operation in our study was 19.7 and 11.5%, respectively. The only factor that was significantly associated with recurrence was the presence of residual cystic disease on the post-operative MRI ( p  < 0.001). Conclusions We propose a follow-up strategy that stratifies patients at “low risk” if there is no residual cyst, with increasing interval scans, or “high risk” if there is residual cyst, with annual visual assessment and scans.