Natural history of Rathke's cleft cysts: A retrospective analysis of a two centres experience

摘要

Summary Objective Rathke's cleft cyst ( RCC ) is a common sellar lesion which may cause visual impairment, hypopituitarism and headaches from mass effect. The natural history of these lesions is currently unclear. We investigated the natural history of RCC s and compared surgically treated patients with those treated conservatively. Methods We performed a retrospective cohort study of patients diagnosed with a RCC between 1996 and 2016 at Stanford University and Ospedale Maggiore Policlinico di Milano. Results Patients were divided into 2 cohorts: Group A, 72 subjects who underwent surgical resection of a symptomatic RCC , and Group B, 62 subjects managed conservatively. Compared to Group B, Group A subjects had larger RCC s (79% vs 22% had a largest diameter 10?mm, P ??.001) and were more likely (41.5% vs 16%, P ??.001) to present with hypopituitarism and diabetes insipidus ( DI ) (18% vs 1.6%, P ?=?.002). In Group A, after a mean follow‐up of 53.7?months, 12.5% of patients had recurrence and a second surgery. After surgery, 35% of patients recovered pituitary function. Hyperprolactinemia (26.6%) and hypogonadism (66.6%) resolved more commonly that did DI (20.1%). New pituitary deficits appeared in 16.6% of patients after surgery. In Group B, with a mean follow‐up of 41?months, only 6.4% had cyst enlargement, none underwent surgery, and none developed a pituitary deficit. Conclusion Our data offer guidance in decision‐making regarding the management of RCC patients and confirm the safety of conservative treatment in asymptomatic patients.