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Menéndez-Torre EL, Gutiérrez-Hurtado A, Ollero MD, Irigaray A, Martín P, Parra P, González-Molero I, Araujo-Castro M, Idrobo C, Moure MD, Molina AR, Biagetti B, Iglesias P, Paja M, Villar-Taibo R, Pena A, Vicente A, Guerrero-Pérez F, Cordido F, Aulinas A, Mateu M, Soto A. Natural history and surgical outcomes of Rathke's cleft cysts: a Spanish multicenter study. Front Endocrinol (Lausanne) 2024; 15:1413810. [PMID: 38952395 PMCID: PMC11215184 DOI: 10.3389/fendo.2024.1413810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/04/2024] [Indexed: 07/03/2024] Open
Abstract
Rathke's cleft cysts (RCC) are a common type of lesion found in the sellar or suprasellar area. They are usually monitored clinically, but in some cases, surgery may be required. However, their natural progression is not yet well understood, and the outcomes of surgery are uncertain. The objective of this study is to evaluate the natural history of Rathke's cleft cysts in patients who are clinically monitored without treatment, and to determine the outcomes of surgery and the incidence of recurrences over time. Design and patients National multicentric study of patients diagnosed of Rathke's cleft cyst (RCC- Spain) from 2000 onwards and followed in 15 tertiary centers of Spain. A total of 177 patients diagnosed of RCC followed for 67.3 months (6-215) and 88 patients who underwent surgery, (81 patients underwent immediate surgery after diagnosis and 7 later for subsequent growth) followed for 68.8 months (3-235). Results The cyst size remained stable or decreased in 73.5% (133) of the patients. Only 44 patients (24.3%) experienced a cyst increase and 9 of them (5.1%) experienced an increase greater than 3 mm. In most of the patients who underwent surgery headaches and visual alterations improved, recurrence was observed in 8 (9.1%) after a median time of 96 months, and no predictors of recurrence were discovered. Conclusions Rathke's cleft cysts without initial compressive symptoms have a low probability of growth, so conservative management is recommended. Patients who undergo transsphenoidal surgery experience rapid clinical improvement, and recurrences are infrequent. However, they can occur after a long period of time, although no predictors of recurrence have been identified.
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Affiliation(s)
- Edelmiro Luis Menéndez-Torre
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Oviedo, Spain
- Grupo ENDO, Instituto de Investigación Biomédica del Principado de Asturias (ISPA), Oviedo, Spain
- Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Alba Gutiérrez-Hurtado
- Department of Endocrinology and Nutrition, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - María Dolores Ollero
- Department of Endocrinology and Nutrition, Hospital Universitario de Navarra, Pamplona, Spain
| | - Ana Irigaray
- Department of Endocrinology and Nutrition, Hospital Universitario de Navarra, Pamplona, Spain
| | - Patricia Martín
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, Madrid, Spain
| | - Paola Parra
- Department of Endocrinology and Nutrition, Hospital Universitario La Paz, Madrid, Spain
| | - Inmaculada González-Molero
- Department of Endocrinology and Nutrition, Hospital Regional Universitario de Málaga, IBIMA Plataforma Bionand, Málaga, Spain
| | - Marta Araujo-Castro
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Cindy Idrobo
- Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - María Dolores Moure
- Department of Endocrinology and Nutrition, Hospital Universitario de Cruces, Baracaldo, Spain
| | - Ana Rosa Molina
- Department of Endocrinology and Nutrition, Hospital Universitario de Cruces, Baracaldo, Spain
| | - Betina Biagetti
- Department of Endocrinology and Nutrition, Hospital Universitario Vall d’Hebrón, Barcelona, Spain
| | - Pedro Iglesias
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Miguel Paja
- Department of Endocrinology and Nutrition, Hospital Universitario de Basurto, Bilbao, Spain
| | - Rocío Villar-Taibo
- Department of Endocrinology and Nutrition, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Pena
- Department of Endocrinology and Nutrition, Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | - Almudena Vicente
- Department of Endocrinology and Nutrition, Hospital Universitario de Toledo, Toledo, Spain
| | - Fernando Guerrero-Pérez
- Department of Endocrinology and Nutrition, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Fernando Cordido
- Department of Endocrinology and Nutrition, Hospital Universitario de Coruña, Coruña, Spain
| | - Anna Aulinas
- Department of Endocrinology and Nutrition, Hospital Sant Pau, Barcelona, Spain
| | - Manel Mateu
- Department of Endocrinology and Nutrition, Hospital Sant Pau, Barcelona, Spain
| | - Alfonso Soto
- Department of Endocrinology and Nutrition, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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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.
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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
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Qian A, Zhou J, Zhang X, Yu J, Wang X. Incidence and factors associated with the recurrence of Rathke's cleft cyst after surgery: A systematic review and meta-analysis. Front Surg 2023; 9:1065316. [PMID: 36684167 PMCID: PMC9849585 DOI: 10.3389/fsurg.2022.1065316] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Backgroud Recurrence of Rathke's cleft cyst (RCC) is not uncommon after surgery, and the associated factors and incidence of relapse deserve a systematic summary. Methods This study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The Pubmed, Embase, Cochrane, and Web of Science databases were searched until September 12, 2022. Studies with significant results of recurrent factors or specific incidences of RCC recurrence and mean/median follow-up time were included. Based on a protocol of a 2-year interval grouping, included studies were categorized into four groups with follow-up periods <24 months, 24-48 months, 48-72 months, and ≥72 months, respectively. Quality assessment was performed using the NOS score. Pooled estimations were computed by using a random-effects model in the STATA "metaprop" command. Publication bias was assessed visually through a funnel plot and statistically through Egger's linear regression test and Begg's correlation test. Results A total of 44 studies were included containing 2,539 cases. Squamous metaplasia was the most commonly reported factor, followed by the extent of cyst removal. The other factors were reported individually. The pooled overall incidences of RCC recurrence after surgery in four groups of the follow-up period were 7.4% (95%CI = 4.1-11.3%) in <24 months, 13.1% (95%CI = 9.7-17.0%) in 24-48 months, 13.7% (95%CI = 7.7-21.0%) in 48-72 months, and 33.8% (95%CI = 19.6-49.6%) in ≥72 months. The pooled symptomatic incidences were 2.3% (95%CI = 0.4-5.1%) in <24 months, 5.6% (95%CI = 3.6-7.9%) in 24-48 months, 5.9% (95%CI = 2.4-10.6%) in 48-72 months, and 14.1% (95%CI = 6.0-24.5%) in ≥72 months. A dramatic increase in recurrent incidence was observed when the follow-up period was more than 72 months in both overall and symptomatic recurrence. A similar trend of recurrence was found in subgroup analyses stratified by publication year, cohort size, and cyst resection strategy. Conclusion This study systematically reviewed recurrent factors and described the profile of trends in RCC recurrent incidence after surgery with a follow-up time based on a protocol of a 2-year interval, finding a dramatic increase in recurrent rates with a follow-up period of more than 72 months. This encouraged us to put forward a recommendation of at least a 6-year follow-up after surgery for patients with RCC. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42021278970.
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