Objective: Rathke’s cleft cysts (RCCs) are nonneoplastic cysts. Most of them are asymptomatic
and stable; when symptomatic, RCCs are surgically fenestrated and drained. However,
the outcomes remain unclear. The authors evaluated the outcomes of RCC decompression.
Methods: Between 2004 and 2019, a total of 32 RCCs were decompressed in a single tertiary
institution. The clinical characteristics, intraoperative findings, postoperative
complications, and endocrinological and surgical outcomes were retrospectively reviewed.
Patients who underwent sequential imaging at least twice and at least 12 months after
surgery were included in the analysis.
Results: Patients’ mean age was 40.8 ± 14.9 years, and 62.5% were women. The mean follow-up
duration was 62.3 ± 48.6 months. In 21 patients (65.6%), no residual cysts were identified
on postoperative magnetic resonance imaging. Of the 18 patients with preoperative
visual field defects, 17 (94.4%) experienced postoperative visual improvement. Postoperative
complications included endocrinological deterioration in 11 patients (34.4%), permanent
diabetes insipidus in 11 (34.4%), infection in 4 (12.5%), intrasellar hemorrhage in
3 (9.4%), and cerebrospinal fluid leak in 2 (6.3%). Follow-up images revealed cyst
recurrence in nine patients (28.1%), an average of 20.4 months after surgery; in three
patients, the cysts were symptomatic, and resection was repeated. Multivariable analysis
revealed that postoperative endocrinological deterioration was the only independent
factor associated with cyst recurrence (p = 0.028; hazard ratio, 6.800).
Conclusion: Our findings showed that although only cyst fenestration for decompression was performed
to preserve pituitary function, more pituitary dysfunction occurred than expected.
Besides, the postoperative hormonal deterioration itself acted as a risk factor for
cyst recurrence. In conclusion, surgery for RCC should be more careful.
