1
|
Sharifi G, Amin Darozzarbi AA, Paraandavaji E, Lotfinia M, Kazemi MA, Hajikarimloo B, Jafari A, Mohammadi E, Davoudi Z, Akbari Dilmaghani N. Vertical triband flag sign for differential diagnosis of Rathke's cleft cyst. World Neurosurg X 2024; 21:100260. [PMID: 38187505 PMCID: PMC10770743 DOI: 10.1016/j.wnsx.2023.100260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/30/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
Background The Rathke cleft cyst (RCC) is a type of cystic growth that is benign, circular, and well-defined with an incidence rate of 4 %. This study aims to identify a useful diagnostic imaging sign that can aid in the differentiation of RCC from other cystic lesions. Methods We retrospectively analyzed the records of 42 symptomatic RCC patients who were referred to our facility between 2016 and 2023. The data for the study were obtained from our electronic database. All magnetic resonance imaging (MRI) studies were performed using a 1.5-T superconducting magnetic scanner. All patients underwent endonasal transsphenoidal surgical resection. All MRIs were reviewed and evaluated by a neurosurgeon and a neuroradiologist. Results There were 8 (19 %) males and 34 (81 %) females with a mean age of 37.2-years. Our study identified a distinct imaging characteristic in 38 of the cases, which we have named the "vertical triband flag sign", due to the growth of the cyst developing a specific appearance. The flag sign was mostly observed only in the T1-images (71.5 %), while in four cases the sign was spotted only in T2-images, and in four cases it appeared in both T1 and T2. In 4 cases, the flag sign was not observed in which further investigations revealed that these cases were suprasellar or small sellar RCCs. The dot sign, which is a characteristic finding in RCCs was only observed in one of our cases. Conclusion Early diagnosis of RCCs may be facilitated by utilizing the vertical triband flag sign.
Collapse
Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arsalan Amin Darozzarbi
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Paraandavaji
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmoud Lotfinia
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Medical Center Saarbruecken, Saarland, Germany
| | - Mohammad Ali Kazemi
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Bardia Hajikarimloo
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Jafari
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma, USA
| | - Zahra Davoudi
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Endocrinology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Akbari Dilmaghani
- Skull Base Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Otolaryngology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
2
|
Sharifi G, Amin A, Lotfinia M, Hallajnejad M, Davoudi Z, Dilmaghani NA, Mirghaed OR. Rathke’s cleft cysts: A single-center case series. Surg Neurol Int 2022; 13:368. [PMID: 36128136 PMCID: PMC9479561 DOI: 10.25259/sni_1096_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 08/02/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Rathke’s cleft cysts (RCCs) are common benign sellar or suprasellar lesions. The aim of this study is to report our experience on the management of 27 RCC cases. Methods: We retrospectively analyzed a series of 27 patients with symptomatic RCC who were referred to our department between January 2016 and January 2020. Data regarding patients’ demographics, clinical evaluations, laboratory and neuroimaging findings, pathologic records, surgical treatment, and complications were extracted from our electronic database. All patients underwent RCC removal through a direct endoscopic endonasal transsphenoidal (EETS) approach, except for two cases. Results: Data of 27 patients (3 men and 24 women; mean age: 38 years) with symptomatic RCC were reviewed. The most common presenting symptom was headache, occurring in 20 (74.0%) patients. In 16 (59.2%) cases, the tumor was primarily located in the sella turcica. Nine (33.3%) cases exhibited a secondary suprasellar extension. Conclusion: Our experience with RCC patients showed that EETS is a safe method of treatment, with minimal recurrence.
Collapse
Affiliation(s)
- Guive Sharifi
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran,
| | - Arsalan Amin
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran,
| | - Mahmoud Lotfinia
- Department of Neurosurgery, Medical Center Saarbruecken, Saarland, Germany,
| | - Mohammad Hallajnejad
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran,
| | - Zahra Davoudi
- Department of Endocrinology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Nader Akbari Dilmaghani
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran,
| | - Omidvar Rezaei Mirghaed
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran,
| |
Collapse
|
3
|
West JL, Soike MH, Renfrow JJ, Chan MD, Laxton AW, Tatter SB. Successful application of stereotactic radiosurgery for multiply recurrent Rathke's cleft cysts. J Neurosurg 2020; 132:832-836. [PMID: 30717059 DOI: 10.3171/2018.9.jns181703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/28/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rathke's cleft cysts (RCCs) are benign lesions of the sella turcica that usually come to neurosurgical attention due to compression of the optic apparatus (OA) and headaches. Treatment options for these lesions include observation, aspiration of cyst contents, or open resection of the cyst with the cyst wall. All of these options involve the potential for cyst recurrence or enlargement. In this study the authors report on a potential new therapeutic option for RCCs, i.e., stereotactic radiosurgery (SRS). METHODS A retrospective review was conducted of 5 patients with histologically confirmed, multiply recurrent RCCs who were treated with single-fraction SRS at a tertiary referral academic medical center. RESULTS The total cohort consisted of 5 female patients with an average age of 31.8 years. The most common presenting symptom was headache followed by blurry vision. The symptoms were present on average for 7 months before intervention. The median number of surgeries prior to radiosurgery was 2. The average volume of lesion treated was 0.34 cm3. The median SRS dose was 12.5 Gy prescribed to the 50% isodose line with an average prescription coverage of 96.6%. The median dose to the OA was 5 Gy. At last follow-up, 3 of 5 cysts had completely regressed, 1 had regressed by more than 50% but was still present, and 1 was stable, with an overall mean follow-up duration of 34.2 months. There were no neurological, endocrinological, or visual complications attributable to SRS during the follow-up period. CONCLUSIONS RCCs can be a challenging clinical entity to treat, especially when they are multiply recurrent. In patients with an average of 2 previous surgeries for resection, a single SRS session prevented recurrence universally, with an average follow-up of almost 3 years. These results indicate that further investigation of the treatment of RCCs with SRS is indicated.
Collapse
Affiliation(s)
| | - Michael H Soike
- 2Radiation Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | | | - Michael D Chan
- 2Radiation Oncology, Wake Forest Baptist Health, Winston-Salem, North Carolina
| | | | | |
Collapse
|
4
|
Tang Y, Wu Y, Zhang H, Wang J, Yao Z. Increased diagnostic confidence in the diagnosis of pituitary micro-lesions with the addition of three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions sequences. Acta Radiol 2019; 60:213-220. [PMID: 29792041 DOI: 10.1177/0284185118774954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conventional magnetic resonance imaging (MRI) is adversely affected by thick slices, small intersection gaps, and the partial volume effect, leading to the missed diagnosis or misdiagnosis of pituitary micro-lesions. PURPOSE To evaluate the diagnostic yield of three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-T2 SPACE) sequences compared with a standard MRI protocol for the diagnosis of pituitary micro-lesions. MATERIAL AND METHODS The MRI findings of 664 patients with clinically suspected pituitary lesions were retrospectively analyzed. All patients underwent coronal 3D-T2 SPACE sequences followed by T1-weighted (T1W) imaging. Conventional scanning sequences included coronal and sagittal T1W imaging and post-contrast enhanced coronal and sagittal T1 imaging. All images were independently evaluated by two experienced neuroradiologists. The inter-observer agreement was analyzed using kappa statistics. RESULTS Compared with conventional sequences, there was an increase in diagnostic confidence of 60.3% for the diagnosis of pituitary micro-lesions with the addition of 3D-T2 SPACE sequences. The lesion conspicuity scores of combined conventional and 3D-T2 SPACE sequences were significantly higher than those of conventional imaging (z = -6.403, P < 0.01) and 3D-T2 SPACE sequences (z = -4.243, P < 0.01). In addition, the inter-observer agreement of 3D-T2 SPACE sequences was good (κ = 0.826). CONCLUSION Combined with routine sequences, post-contrast enhanced 3D-T2 SPACE sequences effectively improve diagnostic confidence in the diagnosis of pituitary micro-lesions. Post-contrast enhanced 3D-T2 SPACE is suitable for detecting pico-adenomas, micro-lesions adjacent to the cavernous sinuses or sellar floor, lesions between the anterior and posterior lobes, and lesions with early phase enhancement.
Collapse
Affiliation(s)
- Ying Tang
- Department of Radiology, Huashan Hosptial, Fudan University, Shanghai 200040, PR China
| | - Yue Wu
- Department of Radiology, Huashan Hosptial, Fudan University, Shanghai 200040, PR China
| | - Hua Zhang
- Department of Radiology, Huashan Hosptial, Fudan University, Shanghai 200040, PR China
| | - Jing Wang
- Department of Radiology, Huashan Hosptial, Fudan University, Shanghai 200040, PR China
| | - ZhenWei Yao
- Department of Radiology, Huashan Hosptial, Fudan University, Shanghai 200040, PR China
| |
Collapse
|