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Atypical visual field defect without major compression from an inflammatory Rathke's cleft cyst: illustrative case.

Sakuya Ohnishi1, Kenta Nakase1, Fumihiko Nishimura1

  • 1Department of Neurosurgery, Nara Medical University, Kashihara, Japan.

Journal of Neurosurgery. Case Lessons
|January 22, 2026
PubMed
Summary

Rathke's cleft cysts (RCCs) can cause vision loss through inflammation, not just compression. Early recognition of inflammatory mechanisms in stable RCCs is vital for prompt surgical treatment and improved visual outcomes.

Keywords:
Rathke’s cleft cystatypical visual field defectsendoscopic endonasal surgeryinflammation

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Area of Science:

  • Neuroscience
  • Ophthalmology
  • Endocrinology

Background:

  • Rathke's cleft cysts (RCCs) are common sellar tumors.
  • Visual field defects are critical indicators for surgical intervention in RCCs.
  • Typical visual field defects include hemianopia and quadrantanopia, but atypical presentations can complicate management.

Purpose of the Study:

  • To investigate a case of atypical visual field defects caused by an incidentally detected Rathke's cleft cyst.
  • To explore the role of inflammatory mechanisms in visual impairment associated with RCCs.
  • To highlight the importance of recognizing inflammation in the management of RCCs.

Main Methods:

  • A case study of a 55-year-old woman with headaches and bilateral paracentral scotoma.
  • Radiographic assessment using MRI to evaluate cyst size and enhancement patterns.
  • Surgical intervention via endoscopic endonasal surgery to drain the cyst.
  • Histopathological examination of the cyst wall.

Main Results:

  • The patient presented with atypical visual field defects despite no radiographic evidence of cyst enlargement.
  • MRI revealed inflammatory enhancement extending from the RCC to the optic chiasm.
  • Endoscopic endonasal surgery led to complete resolution of visual symptoms.
  • Histology confirmed inflammatory cell infiltration of the cyst wall.

Conclusions:

  • Rathke's cleft cysts can cause visual impairment through inflammatory involvement of optic pathways, not solely compression.
  • Radiographically stable RCCs can manifest as atypical visual field defects due to inflammation.
  • Timely surgical intervention based on recognizing inflammatory mechanisms is crucial for favorable visual outcomes.