Rapidly recurrent recalcitrant Rathke Cleft Cyst: Case report and review of the literature

Authors

E J. Chalif, Department of Neurological Surgery, University of California, San Francisco, San Francisco, California; Department of Neurosurgery, The George Washington University, Washington, District of Columbia, United States.
M El Shatanofy, Department of Neurosurgery, The George Washington University, Washington, District of Columbia, United States.
K Mozaffari, Department of Neurosurgery, The George Washington University, Washington, District of Columbia, United States.
S Goyal, Department of Radiation Oncology, The George Washington University, Washington, District of Columbia, United States.
J H. Sherman, Rockefeller Neuroscience Institute, Department of Neurosurgery, West Virginia University, Martinsburg, West Virginia. Electronic address: JSherman0620@gmail.com.

Document Type

Journal Article

Publication Date

3-5-2022

Journal

Neuro-Chirurgie

DOI

10.1016/j.neuchi.2022.01.002

Keywords

RCC; Rathke cleft cyst; Recurrence; Sellar mass; Transsphenoidal surgery

Abstract

BACKGROUND: Rathke Cleft Cysts (RCC) are cystic sellar or suprasellar nonneoplastic lesions that are thought to originate from remnants of the rathke pouch. Postoperatively, RCCs have a tendency to reaccumulate, after which preoperative symptoms may recur. However, there exists very little evidence on which treatments are most effective in these patients. CASE-DESCRIPTION: In this report, we present a unique case of a symptomatic RCC that recurred four times after initial transsphenoidal surgery. Following each surgery, the patient had significant visual improvement with post-op imaging displaying decompression of the neural elements. However, RCC reaccumulated in strikingly rapid time intervals of 1.5 months, 0.5 months, 1.5 years, and 5 months after each respective prior surgery. Repeat interventions with transsphenoidal, pterional and supraorbital approaches were unsuccessful in providing a durable treatment response. The patient ultimately underwent radiotherapy after a final surgical marsupialization of the cyst and has since displayed stable imaging with improved vision. This patient represented a 'perfect storm' of factors that may contribute to cyst recurrence, including substantial visual field deficits, large cyst size, peripheral wall enhancements on MRI, an intraoperative CSF leak, use of a fat graft, subtotal resection of the portion of cyst wall that adhered to important suprasellar structures, squamous metaplasia noted in cyst wall, and suprasellar extension. CONCLUSIONS: We demonstrate that different surgical approaches through repeat surgeries may not assist in prevention of further recurrence; instead, we propose that radiotherapy should be offered early in the treatment course of recurrent cases that have additional risk factors for further reoccurrence.

APA Citation

Chalif, E J.; El Shatanofy, M; Mozaffari, K; Goyal, S; and Sherman, J H., "Rapidly recurrent recalcitrant Rathke Cleft Cyst: Case report and review of the literature" (2022). GW Authored Works. Paper 629.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/629

Department

Neurological Surgery