Surgery versus conservative care for Rathke's cleft cyst.
Adolescent
Adrenal Insufficiency
/ diagnostic imaging
Adult
Aged
Central Nervous System Cysts
/ diagnostic imaging
Cohort Studies
Conservative Treatment
/ methods
Diabetes Insipidus
/ diagnostic imaging
Female
Follow-Up Studies
Headache
/ diagnostic imaging
Humans
Hyperprolactinemia
/ diagnostic imaging
Hypopituitarism
/ diagnostic imaging
Male
Middle Aged
Neurosurgical Procedures
/ methods
Pituitary Neoplasms
/ diagnostic imaging
Retrospective Studies
Young Adult
Neuroendocrinology
Pituitary tumor
RCC Rathke's cleft cyst
Journal
Neuro-Chirurgie
ISSN: 1773-0619
Titre abrégé: Neurochirurgie
Pays: France
ID NLM: 0401057
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
22
09
2019
revised:
15
11
2020
accepted:
25
12
2020
pubmed:
16
1
2021
medline:
6
7
2021
entrez:
15
1
2021
Statut:
ppublish
Résumé
Rathke's cleft cysts are benign cystic lesions of the sellar region, which may cause headache, pituitary deficiencies and visual disturbances from mass effect. Their management is not standardized yet. This study is about establishing a consensus for medical care of RCC. We performed a retrospective observational study of all patients that were diagnosed or followed for RCC between 2008 and 2018 (11 years), in the neurosurgical and the adult endocrine departments of our institution. The study's average time length of follow-up is 72.9 months (from 2 to 385 months). The 57 included patients were divided into 2 groups: group A, which included 39 patients that were conservatively managed and group B, which included 18 surgically treated patients. Group A showed either an improvement or a spontaneous resolution of headaches in 56.1% of the cases (P<0.01); a resolution of hyperprolactinemia in 70% of the cases (P=0.21); and of hypogonadism, ACTH deficiency, growth hormone deficiency in 100% of the cases. There was no spontaneous improvement of visual disturbances (P<0.01) or diabetes insipidus (P=0.29) during follow-up. Regarding group B, surgery allowed improvement or complete resolution of headaches in 60% of the cases; visual troubles in 100% of the cases (P<0.01); and hyperprolactinemia in 100% of the cases. Pituitary deficiencies were not improved by surgery. This study offers guidance in decision-making regarding the management of RCC patients. Surgery is particularly suitable for treating visual disturbances caused by RCC. Regular follow-up is more appropriate than surgery concerning headaches, hyperprolactinemia, endocrine disruptions and diabetes insipidus.
Sections du résumé
BACKGROUND
BACKGROUND
Rathke's cleft cysts are benign cystic lesions of the sellar region, which may cause headache, pituitary deficiencies and visual disturbances from mass effect. Their management is not standardized yet. This study is about establishing a consensus for medical care of RCC.
MATERIAL AND METHODS
METHODS
We performed a retrospective observational study of all patients that were diagnosed or followed for RCC between 2008 and 2018 (11 years), in the neurosurgical and the adult endocrine departments of our institution. The study's average time length of follow-up is 72.9 months (from 2 to 385 months).
RESULTS
RESULTS
The 57 included patients were divided into 2 groups: group A, which included 39 patients that were conservatively managed and group B, which included 18 surgically treated patients. Group A showed either an improvement or a spontaneous resolution of headaches in 56.1% of the cases (P<0.01); a resolution of hyperprolactinemia in 70% of the cases (P=0.21); and of hypogonadism, ACTH deficiency, growth hormone deficiency in 100% of the cases. There was no spontaneous improvement of visual disturbances (P<0.01) or diabetes insipidus (P=0.29) during follow-up. Regarding group B, surgery allowed improvement or complete resolution of headaches in 60% of the cases; visual troubles in 100% of the cases (P<0.01); and hyperprolactinemia in 100% of the cases. Pituitary deficiencies were not improved by surgery.
CONCLUSIONS
CONCLUSIONS
This study offers guidance in decision-making regarding the management of RCC patients. Surgery is particularly suitable for treating visual disturbances caused by RCC. Regular follow-up is more appropriate than surgery concerning headaches, hyperprolactinemia, endocrine disruptions and diabetes insipidus.
Identifiants
pubmed: 33450264
pii: S0028-3770(21)00010-2
doi: 10.1016/j.neuchi.2020.12.010
pii:
doi:
Types de publication
Comparative Study
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
104-111Informations de copyright
Copyright © 2021 Elsevier Masson SAS. All rights reserved.