A Rathke cleft cyst is a rare type of cyst believed to originate from remnants of the Rathke pouch. During embryonic development, Rathke's pouch forms as a depression in the roof of the mouth, eventually losing its connection to the pharynx and giving rise to the anterior pituitary gland. If instead of regressing the cleft persists and enlarges, it may form into a cyst. Most of these cysts are very small (less than 2 mm), cause no symptoms, and are only discovered incidentally from imaging studies for other conditions.
In some instances, continual accumulation of fluid may cause the cyst to grow. As it grows it places pressure on surrounding structures—the pituitary gland, optic chiasm, and/or hypothalamus—resulting in associated symptoms. Rathke cleft cysts are very similar in presentation and origin to craniopharyngiomas. The difference is that craniopharyngiomas grow by cell division and fluid accumulation, whereas Rathke cleft cysts grow only by fluid accumulation.
The preferred surgical treatment at UPMC for Rathke cleft cysts is the Endoscopic Endonasal Approach (EEA). This innovative, minimally invasive technique uses the nose and nasal cavities as natural corridors to access hard-to-reach or previously inoperable tumors. EEA offers the benefits of no incisions to heal, no disfigurement to the patient, and a faster recovery time.
Your doctor will perform a physical exam and ask you about any symptoms you are experiencing. Many Rathke cleft cysts are asymptomatic, which means they do not cause any symptoms. As the cysts get larger, they may press on a surrounding structure. Symptoms associated with compression include pituitary dysfunction, visual disturbances, and headaches.
Imaging studies such as MRI and CT scans can detect the presence of a mass and show its cystic character, but are insufficient for a positive diagnosis. Additional tests must be performed to help rule out other possible diagnoses, such as arachnoid cysts, cystic pituitary adenomas, or epidermoid cysts.
A correct diagnosis is particularly important for Rathke cleft cysts because the treatment differs from that of other possible lesions. The diagnosis is confirmed by a sample of the cystic capsule that is sent to pathological analysis during surgical drainage of the cyst.
For asymptomatic Rathke cleft cysts, long-term observation by a physician may be sufficient. Cysts that are growing and causing symptoms require surgical drainage and/or removal.
The preferred surgical approach at UPMC for treating Rathke cleft cysts is the Endoscopic Endonasal Approach (EEA). This state-of-the-art, minimally invasive surgical procedure uses the nose as a natural corridor to reach these lesions, without any incisions in the face or head.