A COMPREHENSIVE REVIEW OF RATHKE’S CLEFT CYSTS: DIAGNOSTIC CHALLENGES AND MANAGEMENT TRENDS
Abstract
Introduction and purpose: Rathke’s cleft cysts (RCCs) are benign, epithelium-lined lesions located in the sellar or suprasellar region, originating from remnants of Rathke’s pouch. While often asymptomatic and discovered incidentally, RCCs may lead to significant clinical symptoms due to compression of adjacent structures, including the pituitary gland and optic chiasm. The aim of this review is to provide a comprehensive overview of RCCs and emphasize the importance of accurate diagnosis and individualized management, especially in symptomatic cases.
Material and methods: The review is based on scientific literature published between 2005 and 2025, retrieved from PubMed, Scopus and Google Scholar using the following keywords: “Rathke’s cleft cyst,”, “Rathke’s cyst diagnosis,” “Rathke’s cyst treatment,” “pituitary cyst surgery,” and “Rathke’s cyst recurrence”.
Results: Analysis of the literature indicates that although most RCCs remain asymptomatic, a significant subset causes symptoms such as headaches, visual disturbances, and endocrine dysfunction. MRI remains the most effective diagnostic tool, while treatment typically involves transsphenoidal surgical drainage. Recurrence rates vary depending on the surgical technique and inflammatory changes within the cyst wall. Emerging approaches, such as steroid-eluting stents, show promise in reducing recurrence, though further research is needed.
Conclusions: RCCs, though generally benign, may result in substantial morbidity in symptomatic patients. Accurate diagnosis, appropriate imaging, and tailored treatment are essential for optimal outcomes. Long-term follow-up is recommended due to the potential for recurrence, and novel interventions offer promising avenues for future management strategies.
References
Aho, C. J., Liu, C., Zelman, V., Couldwell, W. T., & Weiss, M. H. (2005). Surgical outcomes in 118 patients with Rathke cleft cysts. Journal of Neurosurgery, 102(2), 189–193. https://doi.org/10.3171/jns.2005.102.2.0189
Altuwaijri, N., Cote, D. J., Lamba, N., Albenayan, W., Ren, S. P., Zaghloul, I., Doucette, J., Zaidi, H. A., Mekary, R. A., & Smith, T. R. (2018). Headache Resolution After Rathke Cleft Cyst Resection: A Meta-Analysis. World Neurosurgery, 111, e764–e772. https://doi.org/10.1016/j.wneu.2017.12.170
Azuma, M., Khant, Z. A., Kitajima, M., Uetani, H., Watanabe, T., Yokogami, K., Takeshima, H., & Hirai, T. (2020). Usefulness of Contrast-Enhanced 3D-FLAIR MR Imaging for Differentiating Rathke Cleft Cyst from Cystic Craniopharyngioma. AJNR: American Journal of Neuroradiology, 41(1), 106–110. https://doi.org/10.3174/ajnr.A6359
Candy, N. G., Mignone, E., Quick, E., Koszyca, B., Brown, A., Chapman, I. M., Torpy, D. J., Vrodos, N., Santoreneos, S., & De Sousa, S. M. C. (2025). The role of BRAF testing of Rathke’s cleft cysts to identify missed papillary craniopharyngioma. Pituitary, 28(1), 30. https://doi.org/10.1007/s11102-025-01501-8
Dadej, D., Skraba, K., Matyjaszek-Matuszek, B., Świrska, J., Ruchała, M., & Ziemnicka, K. (2021). Presenting symptoms and endocrine dysfunction in Rathke cleft cysts—A two-centre experience. Endokrynologia Polska, 72(5), 505–511. https://doi.org/10.5603/EP.a2021.0091
Dolovac, R. B., King, J., Ovenden, C., Kam, J., Wang, Y. Y., Goldschlager, T., & Castle-Kirszbaum, M. (2025). Impact of sella floor reconstruction on Rathke Cleft Cyst recurrence: A systematic review and meta-analysis. Pituitary, 28(3), 49. https://doi.org/10.1007/s11102-025-01521-4
Ference, E. H., Badran, K. W., Kuan, E. C., Bergsneider, M., Heaney, A. P., & Wang, M. B. (2019). Bioabsorbable Steroid Eluting Stents in the Treatment of Recurrent Rathke’s Cleft Cyst. Journal of Neurological Surgery. Part B, Skull Base, 80(5), 505–510. https://doi.org/10.1055/s-0038-1675558
Hacioglu, A., Tekiner, H., Altinoz, M. A., Ekinci, G., Bonneville, J.-F., Yaltirik, K., Sav, A., Ture, U., & Kelestimur, F. (2025). Rathke’s cleft cyst: From history to molecular genetics. Reviews in Endocrine & Metabolic Disorders, 26(2), 229–260. https://doi.org/10.1007/s11154-025-09949-6
Han, S. J., Rolston, J. D., Jahangiri, A., & Aghi, M. K. (2014). Rathke’s cleft cysts: Review of natural history and surgical outcomes. Journal of Neuro-Oncology, 117(2), 197–203. https://doi.org/10.1007/s11060-013-1272-6
Hasebe, M., Tsukaguchi, R., Shibue, K., & Hamasaki, A. (2025). Conservative Management of Symptomatic Rathke Cleft Cyst With Recurrent Inflammatory Remission. JCEM Case Reports, 3(3), luaf008. https://doi.org/10.1210/jcemcr/luaf008
Kanter, A. S., Sansur, C. A., Jane, J. A. J., & Laws, E. R. J. (2006). Rathke’s cleft cysts. Frontiers of Hormone Research, 34, 127–157. https://doi.org/10.1159/000091579
Kasperbauer, J. L., Orvidas, L. J., Atkinson, J. L. D., & Abboud, C. F. (2002). Rathke cleft cyst: Diagnostic and therapeutic considerations. The Laryngoscope, 112(10), 1836–1839. https://doi.org/10.1097/00005537-200210000-00024
Larkin, S., Karavitaki, N., & Ansorge, O. (2014). Rathke’s cleft cyst. Handbook of Clinical Neurology, 124, 255–269. https://doi.org/10.1016/B978-0-444-59602-4.00017-4
Lee, C., & Park, S.-H. (2019). Spontaneously Regressed Rathke’s Cleft Cyst. Journal of Korean Neurosurgical Society, 62(6), 723–726. https://doi.org/10.3340/jkns.2018.0225
Lešták, J., Kynčl, M., Haninec, P., Fůs, M., Eis, V., & Mandys, V. (2025). Chiasmatic syndrome caused by Rathke’s cleft cyst: A case report. Molecular and Clinical Oncology, 22(6), 47. https://doi.org/10.3892/mco.2025.2842
Oyesiku, N. M., & Post, K. D. (2011). Rathke cleft cysts. Neurosurgical Focus, 31(1), Introduction. https://doi.org/10.3171/2011.5.FOCUS11116
Raghunath, A., Sampath, S., Devi, B. I., Chandramouli, B. A., Lal, G. J., Chickabasaviah, Y. T., & Bharath, R. D. (2010). Is there a need to diagnose Rathke’s cleft cyst preoperatively? Neurology India, 58(1), 69–73. https://doi.org/10.4103/0028-3886.60402
Trifanescu, R., Ansorge, O., Wass, J. A. H., Grossman, A. B., & Karavitaki, N. (2012). Rathke’s cleft cysts. Clinical Endocrinology, 76(2), 151–160. https://doi.org/10.1111/j.1365-2265.2011.04235.x
Zada, G. (2011). Rathke cleft cysts: A review of clinical and surgical management. Neurosurgical Focus, 31(1), E1. https://doi.org/10.3171/2011.5.FOCUS1183
Zhong, W., You, C., Jiang, S., Huang, S., Chen, H., Liu, J., Zhou, P., Liu, Y., & Cai, B. (2012). Symptomatic Rathke cleft cyst. Journal of Clinical Neuroscience, 19(4), 501–508. https://doi.org/10.1016/j.jocn.2011.07.022
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