Hemorrhagic Presentation of Rathke Cleft Cysts: A Surgical Case Series

Area of Science:

• Neurosurgery
• Endocrinology
• Pathology

Background:

• Rathke cleft cysts (RCCs) are typically benign sellar/suprasellar lesions found incidentally.
• Rarely, RCCs hemorrhage, presenting symptoms similar to pituitary apoplexy.

Purpose of the Study:

• To review hemorrhagic RCC cases presenting with acute symptoms.
• To inform physicians about this rare clinical presentation and its management.

Main Methods:

• Database review of >1700 transsphenoidal pituitary operations.
• Identification of pathologically confirmed RCCs with acute hemorrhage.
• Surgical treatment via transsphenoidal fenestration and drainage.

Main Results:

• 6 out of 119 RCCs (5.0%) presented with hemorrhage mimicking pituitary apoplexy.
• Symptoms included headache, vision loss, and oculomotor nerve palsy.
• Surgical outcomes were excellent with no major complications; some vision and headache improvement noted.

Conclusions:

• Hemorrhagic RCCs can be misdiagnosed as pituitary apoplexy.
• Treatment at tertiary pituitary centers yields excellent outcomes.
• While some endocrine functions may improve, pituitary axis deficits often persist.