Rathke's Cleft Cyst

Rathke’s Cleft Cysts (RCC) are benign cystic fluid collections that arise inside or above pituitary gland and may cause loss of pituitary hormonal function, visual loss and headaches.

For the great majority of patients with a symptomatic RCC, transsphenoidal surgical removal (via the nose) is the treatment of choice. Fortunately, there have been major technical advances in this surgical approach over the last 15 years, including use of high-definition endoscopy, surgical navigation techniques and more effective skull base closure methods. At Saint John’s Pituitary Disorders Program, we have one of the world’s largest experiences in endonasal endoscopic surgery.  By incorporating cutting edge technology and instrumentation with proven surgical experience of over 1600 endonasal surgeries, we make Rathke's Cleft Cyst surgery safer, less invasive and more effective. Dr. Kelly and his team also have a large surgical experience treating patients who have had prior surgery for a RCC.

Learn more about our multidisciplinary team of Neurosurgery, Endocrinology, Otolaryngology, Radiation Oncology, Neuro-Ophthalmology and Neuro-Oncology.

Overview

Rathke’s Cleft Cysts are not true tumors or neoplasms; instead they are benign cysts. Rathke’s pouch forms as part of normal development and eventually forms the anterior lobe, pars intermedia and pars tuberalis, of the Pituitary Gland. This pouch normally closes in fetal development, but a remnant often persists as a cleft that lies between the anterior and posterior lobes of the pituitary gland. Occasionally, this remnant enlarges to form a cyst. RCCs can cause pituitary failure, headaches and in some instances, vision loss.

Diagnosis

Symptomatic RCCs are relatively common pituitary lesions, accounting for 5-10% of surgically removed pituitary masses. RCCs can be seen at any age, although most are identified in adults. Intrasellar RCCs are usually asymptomatic and are found incidentally at autopsy or on a magnetic resonance imaging (MRI) scan. However, larger RCCs may cause visual disturbances, symptoms of pituitary dysfunction, and headaches.

The typical means of visualizing a RCC is with an MRI or a computer tomography (CT) scan of the pituitary region performed without and with contrast. A complete pituitary hormonal blood evaluation should also be performed. Other possible diagnoses to consider when a cystic mass is seen in the area of the pituitary include a cystic pituitary adenoma, craniopharyngioma or arachnoid cyst.

Rathkes Cleft Cyst Diagnosis Pic 1  Rathkes Cleft Cyst Diagnosis Pic 2

Treatment

Rathke's Cleft Cyst surgery is the standard treatment for symptomatic RCCs causing pituitary failure, headache or visual loss. Typically, this requires surgical removal through an Endonasal Surgery. The goal of surgery is to completely remove the cyst contents while improving or preserving pituitary function vision and alleviating headache and visual loss if present. Attempts to remove the cyst lining should be avoided because this can result in pituitary gland damage. A complete removal of RCCs is possible in 80-95% of cases although they can recur at a rate of 5 – 15% over 5 to 10 years.

See more: Endoscopic & keyhole surgery videos on BTC YouTube Channel.