J Neurol Surg B Skull Base 2015; 76 - A062
DOI: 10.1055/s-0035-1546529

Rathke Cleft Cyst: Characteristics Based on the Cyst Location with Primary Focus on Recurrence

Silky Chotai 1, Yi Liu 1, Jun Pan 1, Songtao Qi 1
  • 1Nanfang Hospital, Southern Medical University, Guangzhou, China

Objective: Rathke cleft cyst (RCC) are benign lesions located entirely intrasellar (IS), IS with suprasellar extension (IS + SS) and purely suprasellar (SS) location. The present study was conducted to analyze the predictors of squamous metaplasia (SM) and recurrence in RCC.

Method: A retrospective review of medical records was conducted for 87 patients with symptomatic RCCs. The effect of SM on recurrence in each location was analyzed.

Results: A total of 16 patients had an IS RCC, 21 SS, and 50 IS + SS RCC. The mean age of 64 females and 23 male patients was 41 ± 14 years (range, 10–73 years). Mean cyst volume was 3.1 ± 0.9 cm3. Transsphenoidal approach was employed for all IS and (33/50) IS + SS RCCs and transcranial for all SS and (17/50)IS + SS RCCs. SM was present in 27 of 87 patients, which was associated with SS location (p = 0.003), size (p = 0.023), hypointensity on T1 (16/27, p = 0.005) and isointensity on T2-weighted (19/27, p = 0.002), and ring enhancement on gadolinium-enhanced MRI (p = 0.001). The SS location (p = 0.048; OR, 3.89; and CI, 1.010–15.020), ring enhancement on gadolinium-enhanced MRI (p = 0.028; OR, 3.922; and CI, 1.158–13.288), hypointensity on T1-weighted (p = 0.002; OR, 6.86; and CI, 1.972–23.909), and volume (p = 0.01; OR, 0.367, and CI, 0.170–0.789) were the independent predictors of SM. The mean time to reaccumulation (11/87,12.6%) and recurrence (7/87, 8%) was 14 ± 6 months. The RFS was 84.5% at mean 98.2 ± 4.6 months. The SS location of the cyst (p = 0.007; OR, 7.7; and CI, 1.75–34.54), occurrence of SM (p = 0.007; OR, 19.3; and CI, 2.25–165.18), and isointensity on T2-weighted MRI (p = 0.041; OR, 10.29; and CI, 1.094–96.872) were the independent predictors of RCC recurrence.

Conclusion: The SS location and the ring enhancement on the MRI, hypointensity on T1-weighted MRI, and volume of cyst were predictors of SM. The SS location, occurrence of SM, and isointensity on T2-weighted MRI were the predictors of recurrence. The extent of resection and type of surgical approach used was not associated with recurrence.