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  • Title: Endocrinopathy, vision, headache, and recurrence after transsphenoidal surgery for Rathke cleft cysts.
    Author: Wait SD, Garrett MP, Little AS, Killory BD, White WL.
    Journal: Neurosurgery; 2010 Sep; 67(3):837-43; discussion 843. PubMed ID: 20657318.
    Abstract:
    BACKGROUND: Rathke cleft cyst can enlarge and become symptomatic. OBJECTIVE: To review the clinical data and results of all patients treated by the senior author for a Rathke cleft cyst. METHODS: A prospectively maintained surgical database, supplemented with updates from telephone conversations, of all patients presenting to the Barrow Neurological Institute from 1992 to the present was reviewed. RESULTS: Seventy-three patients (17 males, 56 females; mean age, 40 years; range, 5-80 years) underwent 77 resections. The mean length of follow-up was 27 months (range, 0-129 months). Presenting symptoms included headache (75%), followed by endocrinopathy (49%), and visual symptoms (39%). Preoperative chiasmopathy resolved in 75% and improved in 21% of the patients. Patients' preoperative endocrinopathy resolved at various rates, depending on the specific axis (29%-100%). Endocrinopathies were more likely to resolve in females than males. New postoperative endocrinopathies also occurred (0-8%). Headache resolved (68%) or improved (21%) in most patients. No patient had worsened headaches. Eight patients had a recurrence, 4 of whom underwent reoperation. The presence of squamous metaplasia was the only predictor of recurrence. CONCLUSION: Surgical fenestration and/or resection of Rathke cleft cyst via the transsphenoidal approach are a rational choice for surgical management of these lesions when symptomatic. In most cases, visual symptoms and headache can be expected to improve. New persistent endocrine deficits can be expected in a small percentage of patients, but preexisting endocrinopathies resolve in many patients.
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