Surgical indication of pediatric Rathke’s cleft cyst based on a 20-year retrospective cohort
Jong Seok Lee
Jong Seok LeeDivision of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children’s Hospital, Seoul; Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul;
恩俊KohDivision of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children’s Hospital, Seoul; Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul;
Ji Hoon PhiDivision of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children’s Hospital, Seoul; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul;
Ji Yeoun LeeDivision of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children’s Hospital, Seoul; Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; Department of Anatomy and Cell Biology, Neural Development and Anomaly Laboratory, Seoul National University College of Medicine, Seoul;
Kyung Hyun KimDivision of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children’s Hospital, Seoul; Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul;
Seung-Ki KimDivision of Pediatric Neurosurgery, Pediatric Clinical Neuroscience Center, Seoul National University Children’s Hospital, Seoul; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul National University College of Medicine, Seoul;
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.
开云体育世界杯赔率
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.
ABBREVIATIONS
AUC = area under the curve;BHS = basal hormone study;DI = diabetes insipidus;EEA = endoscopic endonasal approach;RCC = Rathke’s cleft cyst;ROC = receiver operating characteristic;VA = visual acuity;VFD = visual field defect.
CorrespondenceSeung-Ki Kim: Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.nsthomas@snu.ac.kr.
INCLUDE WHEN CITINGPublished online September 1, 2023; DOI: 10.3171/2023.7.PEDS23181.
DisclosuresThe authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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