Poster Presentation ESA-SRB-ANZOS 2025 in conjunction with ENSA

A Single Centre Review of Surgical Outcomes of Rathke’s Cleft Cysts (128565)

Rohit Srivatsa 1 , George Yang 1 , Christopher J Yates 1 , James A King 2 , Yi Zhao 3 , Spiros Fourlanos 1 , Angeline JJ Shen 1
  1. Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Parkville, VIC, Australia
  2. Department of Neurosurgery, The Royal Melbourne Hospital, Parkville, VIC, Australia
  3. Department of Otolaryngology, Head & Neck Surgery, The Royal Melbourne Hospital, Parkville, VIC, Australia

Background: Rathke’s cleft cysts (RCC) are benign sellar lesions comprising 6-10% of symptomatic pituitary lesions.1 Long-term outcome data in Australia is limited.

Aim: To characterise long-term outcomes of surgically treated RCCs at a single Australian tertiary centre and identify predictors of recurrence requiring operation.

Methods: A retrospective review of RCC patients treated at The Royal Melbourne Hospital and Melbourne Private Hospital from 1993–2025. Clinical data were obtained from medical records.

Results: Forty patients (65% female) with median age of 49 years at diagnosis (IQR 34.8-59.5) were included. The median follow-up was 4.1 years (IQR 2.16-9.04). Compressive symptoms (87.5%) including headache and visual disturbance were common. Pituitary dysfunction was present in 12 patients (28%), most commonly, hypogonadotrophic hypogonadism (20%), hypocortisolism (17.5%). Five patients (12.5%) had hyperprolactinaemia secondary to stalk effect. Median RCC size was 18mm (IQR 16-23). Targeted MRI identified suprasellar extension in 34 lesions (87.5%). Thirty-eight patients (95%) underwent transsphenoidal surgery (14 gross total, 26 subtotal) and 2 patients (5%) had pterional craniotomies. CSF leak occurred in 7.5%. New pituitary hormone deficiency occurred in 8 patients (20%) post operatively: 7 patients (17.5%) developed hypocortisolism, 5 patients developed vasopressin deficiency (12.5%) of which 3 were permanent. Compressive symptoms resolved in 27 patients (77.1%) post-operatively. Pituitary function recovered in 6 patients (50%). Nine patients (22.5%) had RCC recurrence or regrowth requiring re-operation. The median time to first radiological recurrence was 10.6 months (IQR 5.2-26.6), and re-operation was 24.7 months (IQR 6.7-36.8). There was no mortality within the follow-up period. Regrowth rate was higher in the group that required reoperation (13.5mm/year versus 2.3mm/year, p<0.05).

Conclusion: Surgery effectively alleviates compressive symptoms of RCCs, but anterior pituitary dysfunction often persists. Rapid regrowth may be a predictor of recurrence requiring intervention. Further studies are needed to validate these findings.

  1. Kasperbauer JL, Orvidas LJ, Atkinson JL, Abboud CF. Rathke cleft cyst: diagnostic and therapeutic considerations. Laryngoscope. 2002;112(10):1836-9.