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Updated: Jul 17, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Surgical indication of pediatric Rathke's cleft cyst based on a 20-year retrospective cohort
Jong Seok Lee1,2, Yong Hwy Kim2, Eun Jung Koh1,2
11Division of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul.
Insights
Pediatric Rathke's cleft cysts (RCCs) often require surgery for vision issues. While surgery can improve headaches and endocrine problems, observation may yield similar headache relief, and endocrine issues can worsen post-surgery.
Area of Science:
- Pediatric Neurosurgery
- Endocrinology
- Ophthalmology
Background:
- Rathke's cleft cyst (RCC) is the most common pediatric pituitary incidentaloma.
- Limited data exists on the natural history and optimal treatment of pediatric RCCs.
- Understanding pediatric RCCs is crucial due to their rarity and potential impact on vision and endocrine function.
Purpose of the Study:
- To elucidate the natural history of pediatric Rathke's cleft cysts (RCCs).
- To determine appropriate surgical indications for pediatric RCCs.
- To compare clinical outcomes between surgical and observational management of pediatric RCCs.
Main Methods:
- Retrospective review of pediatric RCC cases (2000-2022).
- Analysis of clinical presentations, imaging, ophthalmological, and endocrine evaluations.
- Comparison of surgical outcomes versus observation for pediatric RCCs.
Main Results:
- Headache improved in 86.2% after surgery vs. 70.0% with observation; ophthalmological abnormalities resolved in 93.3% post-surgery.
- Surgery group showed higher rates of endocrine abnormality improvement (14.6%) and deterioration (43.9%).
- Endoscopic endonasal approach with partial resection had higher recurrence (26.9%) but fewer endocrine issues (30.8%) than total resection.
Conclusions:
- Ophthalmological abnormalities are the primary surgical indication for pediatric RCCs.
- Surgery may improve headaches and partial endocrine issues, but these are not absolute indications.
- Endoscopic endonasal partial resection is recommended; regular follow-up is vital for visual defects and recurrence.
Objective:
Rathke's cleft cyst (RCC) is the most commonly encountered pituitary incidentaloma in children. Because RCC is not frequently diagnosed in children, there are few reports on pediatric RCCs. The natural course of the disease and appropriate treatments are still obscure. The present study aimed to elucidate the natural history and surgical indications of RCCs in children.
Methods:
The authors retrospectively reviewed the clinical presentations, imaging features, ophthalmological evaluations, endocrine evaluations, and surgical outcomes of pediatric RCCs at a single institution from January 2000 to October 2022. Clinical outcomes between the surgery and observation groups were compared.
Results:
Among 93 patients, there were 41 patients in the surgery group and 52 patients in the observation group. The mean age at diagnosis was 10.9 years, and the mean follow-up period was 5.6 years. Headache fully or partially improved after surgery (86.2%), but the rate of improvement was not different from that of the observation group (70.0%). Ophthalmological abnormalities were effectively improved by surgical treatment (93.3%). Both the improvement and deterioration rates of endocrine abnormalities were significantly higher in the surgery group (p = 0.026 and p < 0.001, respectively), but the deterioration rate (43.9%) was higher than the improvement rate (14.6%). In the surgery group, the recurrence rate was 17.1% and the reoperation rate was 4.9%. Compared with total cyst wall resection, cyst fenestration with partial wall resection was associated with a higher recurrence rate (26.9%, p = 0.035) but a lower rate of endocrine abnormalities (30.8%, p = 0.049).
Conclusions:
Pediatric RCCs of ≥ 10 mm in size were analyzed. Ophthalmological abnormalities are the major surgical indications for pediatric RCCs. Headache and partial endocrine abnormalities may be improved with surgery, but they are not absolute indications for surgery. Cyst fenestration with partial wall resection via an endoscopic endonasal approach is the most recommended surgical method. Follow-up is essential to monitor for the occurrence of visual field defects and the recurrence of cysts.
