A Data-Driven Approach for Rathke’s Cleft Cysts Management
<b>Background:</b> Rathke’s cleft cysts (RCCs) are non-neoplastic and rare sellar lesions derived from remnants of Rathke’s pouch. While asymptomatic RCCs often require only conservative management, symptomatic cases may necessitate surgical intervention. The aim of our study is to inves...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-04-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/15/7/886 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849730730812243968 |
|---|---|
| author | Alberto D’Amico Martina Cappelletti Nicola Bresolin Elisabetta Marton Luca Denaro Giuseppe Canova |
| author_facet | Alberto D’Amico Martina Cappelletti Nicola Bresolin Elisabetta Marton Luca Denaro Giuseppe Canova |
| author_sort | Alberto D’Amico |
| collection | DOAJ |
| description | <b>Background:</b> Rathke’s cleft cysts (RCCs) are non-neoplastic and rare sellar lesions derived from remnants of Rathke’s pouch. While asymptomatic RCCs often require only conservative management, symptomatic cases may necessitate surgical intervention. The aim of our study is to investigate the correlations between clinical, radiological and histological features of RCCs to propose a novel management model. <b>Methods</b>: We conducted a retrospective analysis from patients who underwent surgery for cystic lesions between 2013 and 2023 in the Neurosurgery Department of Treviso Hospital (Italy) using for our purpose only those confirmed by histological specimen as RCCs. <b>Results:</b> 20 patients for a total of 24 procedures (20 primary surgeries/4 cases for recurrence) were performed for RCCs. A gross total resection was achieved in 23 cases, resulting in improvement of headache and visual symptoms in all patients. Hyperintensity on T1-weighted MRI sequences is more strongly correlated with inflammation and with intralesional metaplasia (<i>p</i> = 0.009). Both characteristics are involved in the development of hypopituitarism (<i>p</i> = 0.057), headache, and visual impairment (<i>p</i> = 0.082) compared to cysts with CSF-like content, even when the latter are smaller in size (<i>p</i> = 0.078). Discussion and <b>Conclusions:</b> RCCs are rare lesions whose management is challenging due to a lack of established guidelines. Intraoperative cystic content and MRI cystic characteristics seem to correlate with clinical presentation and long-term outcome in these patients. The transsphenoidal endoscopic approach is a safe and effective treatment, especially in cysts with inflammatory aspect in histopathological specimens and in dedicated MRI sequences that could take advantage of an early surgical resection. A decision-making model based on clinical, radiological and histopathological features of cysts could be useful to guide RCCs’ treatment, underlining the role of inflammation that seems to be involved in the onset of visual and hormonal impairment and in recurrence risk. |
| format | Article |
| id | doaj-art-668ede6d6970446c979a4c304aec39ef |
| institution | DOAJ |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj-art-668ede6d6970446c979a4c304aec39ef2025-08-20T03:08:47ZengMDPI AGDiagnostics2075-44182025-04-0115788610.3390/diagnostics15070886A Data-Driven Approach for Rathke’s Cleft Cysts ManagementAlberto D’Amico0Martina Cappelletti1Nicola Bresolin2Elisabetta Marton3Luca Denaro4Giuseppe Canova5Academic Neurosurgery, Department of Neurosciences, University of Padova, 35128 Padova, ItalyNeurosurgery Unit, AULSS2 Marca Trevigiana, Treviso Hospital, 31100 Treviso, ItalyAcademic Neurosurgery, Department of Neurosciences, University of Padova, 35128 Padova, ItalyNeurosurgery Unit, AULSS2 Marca Trevigiana, Treviso Hospital, 31100 Treviso, ItalyAcademic Neurosurgery, Department of Neurosciences, University of Padova, 35128 Padova, ItalyNeurosurgery Unit, AULSS2 Marca Trevigiana, Treviso Hospital, 31100 Treviso, Italy<b>Background:</b> Rathke’s cleft cysts (RCCs) are non-neoplastic and rare sellar lesions derived from remnants of Rathke’s pouch. While asymptomatic RCCs often require only conservative management, symptomatic cases may necessitate surgical intervention. The aim of our study is to investigate the correlations between clinical, radiological and histological features of RCCs to propose a novel management model. <b>Methods</b>: We conducted a retrospective analysis from patients who underwent surgery for cystic lesions between 2013 and 2023 in the Neurosurgery Department of Treviso Hospital (Italy) using for our purpose only those confirmed by histological specimen as RCCs. <b>Results:</b> 20 patients for a total of 24 procedures (20 primary surgeries/4 cases for recurrence) were performed for RCCs. A gross total resection was achieved in 23 cases, resulting in improvement of headache and visual symptoms in all patients. Hyperintensity on T1-weighted MRI sequences is more strongly correlated with inflammation and with intralesional metaplasia (<i>p</i> = 0.009). Both characteristics are involved in the development of hypopituitarism (<i>p</i> = 0.057), headache, and visual impairment (<i>p</i> = 0.082) compared to cysts with CSF-like content, even when the latter are smaller in size (<i>p</i> = 0.078). Discussion and <b>Conclusions:</b> RCCs are rare lesions whose management is challenging due to a lack of established guidelines. Intraoperative cystic content and MRI cystic characteristics seem to correlate with clinical presentation and long-term outcome in these patients. The transsphenoidal endoscopic approach is a safe and effective treatment, especially in cysts with inflammatory aspect in histopathological specimens and in dedicated MRI sequences that could take advantage of an early surgical resection. A decision-making model based on clinical, radiological and histopathological features of cysts could be useful to guide RCCs’ treatment, underlining the role of inflammation that seems to be involved in the onset of visual and hormonal impairment and in recurrence risk.https://www.mdpi.com/2075-4418/15/7/886Rathke’s cleft cystsmanagement modelcystic sellar lesionheadachetranssphenoidal surgery |
| spellingShingle | Alberto D’Amico Martina Cappelletti Nicola Bresolin Elisabetta Marton Luca Denaro Giuseppe Canova A Data-Driven Approach for Rathke’s Cleft Cysts Management Diagnostics Rathke’s cleft cysts management model cystic sellar lesion headache transsphenoidal surgery |
| title | A Data-Driven Approach for Rathke’s Cleft Cysts Management |
| title_full | A Data-Driven Approach for Rathke’s Cleft Cysts Management |
| title_fullStr | A Data-Driven Approach for Rathke’s Cleft Cysts Management |
| title_full_unstemmed | A Data-Driven Approach for Rathke’s Cleft Cysts Management |
| title_short | A Data-Driven Approach for Rathke’s Cleft Cysts Management |
| title_sort | data driven approach for rathke s cleft cysts management |
| topic | Rathke’s cleft cysts management model cystic sellar lesion headache transsphenoidal surgery |
| url | https://www.mdpi.com/2075-4418/15/7/886 |
| work_keys_str_mv | AT albertodamico adatadrivenapproachforrathkescleftcystsmanagement AT martinacappelletti adatadrivenapproachforrathkescleftcystsmanagement AT nicolabresolin adatadrivenapproachforrathkescleftcystsmanagement AT elisabettamarton adatadrivenapproachforrathkescleftcystsmanagement AT lucadenaro adatadrivenapproachforrathkescleftcystsmanagement AT giuseppecanova adatadrivenapproachforrathkescleftcystsmanagement AT albertodamico datadrivenapproachforrathkescleftcystsmanagement AT martinacappelletti datadrivenapproachforrathkescleftcystsmanagement AT nicolabresolin datadrivenapproachforrathkescleftcystsmanagement AT elisabettamarton datadrivenapproachforrathkescleftcystsmanagement AT lucadenaro datadrivenapproachforrathkescleftcystsmanagement AT giuseppecanova datadrivenapproachforrathkescleftcystsmanagement |