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Hemorrhagic Presentation of Rathke Cleft Cysts: A Surgical Case Series
- Source :
- Operative Neurosurgery. 18:470-479
- Publication Year :
- 2019
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2019.
-
Abstract
- Background Rathke cleft cysts (RCCs) are benign sellar and suprasellar lesions commonly presenting as asymptomatic incidental findings. Rarely, RCCs hemorrhage and mimic pituitary apoplexy on presentation. Objective To review a series of hemorrhagic RCCs for physicians encountering this rare presentation. Methods A database review of >1700 transsphenoidal pituitary operations was performed at the USC Pituitary Center to identify patients with pathologically confirmed RCCs presenting with acute symptoms and evidence of hemorrhage at the time of surgery. Surgical treatment involved transsphenoidal RCC fenestration and drainage. Clinical, endocrine, and imaging outcomes were reviewed. Results A total of 119 RCCs were identified, and 6 (5.0%) presented with hemorrhage mimicking pituitary apoplexy. Presenting symptoms included acute onset headaches (5/6), vision loss (2/6), and oculomotor nerve palsy (n = 1). Endocrine disturbances at presentation included pre-existing amenorrhea in all female patients (3/3), hypothyroidism (n = 2), panhypopituitarism (n = 2), and one with profound hyponatremia (Na 116 meq/L). All patients underwent endonasal transsphenoidal fenestration and drainage with no major complications. Over mean follow-up of 38.4 mo, 2/2 patients with vision loss reported improvement, and 2/5 patients with headaches reported improvement. Although all women resumed menses, patients with preoperative hypopituitarism did not experience pituitary axis improvement. Follow-up magnetic resonance imaging showed no instances of RCC recurrence with a mean imaging follow-up of 38.6 mo. Conclusion RCCs occasionally present with hemorrhage and clinical symptoms that may be confused with apoplexy. Outcomes following hemorrhagic RCC treatment are excellent when treated at tertiary pituitary centers. Although hyperprolactinemia often improves following surgery, other pituitary axis deficits typically do not.
- Subjects :
- medicine.medical_specialty
Pituitary gland
Hemorrhage
030209 endocrinology & metabolism
Hypopituitarism
urologic and male genital diseases
Preoperative care
Asymptomatic
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Oculomotor nerve palsy
Central Nervous System Cysts
Retrospective Studies
business.industry
Pituitary apoplexy
medicine.disease
Surgery
medicine.anatomical_structure
Female
Neurology (clinical)
Neoplasm Recurrence, Local
Headaches
medicine.symptom
business
Hyponatremia
Pituitary Apoplexy
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 23324260 and 23324252
- Volume :
- 18
- Database :
- OpenAIRE
- Journal :
- Operative Neurosurgery
- Accession number :
- edsair.doi.dedup.....6aec5a0a19fc3554f482d6d05efe80cf