Recovery of Pituitary and Visual Function After Rathke's Cleft Cyst Decompression: An 80-case Institutional Experience.

PURPOSE: Rathke's cleft cyst can lead to visual and pituitary dysfunction. Surgical decompression may alleviate these issues, but the decision to operate remains controversial because of the risk of worsening function.

METHODS

A retrospective analysis was conducted on 80 patients who underwent endoscopic transnasal transsphenoidal surgery for Rathke's cleft cyst from April 2018 to April 2024. Clinical outcomes were assessed using magnetic resonance imaging, intraoperative findings, and histopathology to evaluate factors associated with recovery.

RESULTS

After a median follow-up of 13.5 months (interquartile range: 6-30.8 months), anterior pituitary function significantly improved in patients with cysts that did not compress the optic nerve and had minimal thinning of the ganglion cell layer-inner plexiform layer (P < .05). Arginine vasopressin deficiency occurred significantly more often in patients with preoperative adult GH deficiency, a history of surgery, and evidence of inflammation in specimens on pathology (P < .05). Retinal nerve fiber layer thickness correlated with visual field impairment both before and after surgery, suggesting it may predict visual recovery.

CONCLUSION

Decompression of Rathke's cleft cysts can improve anterior pituitary function in patients with smaller cysts and minimal optic nerve pressure. Visual function will likely improve in those with minimal optic nerve fiber layer thinning. Therefore, preoperative optical coherence tomography and visual field testing are mandatory to set expectations regarding potential improvement in vision and anterior pituitary function following surgery. Patients with preoperative adult GH deficiency and a history of surgery are at higher risk of developing postoperative arginine vasopressin deficiency.