{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T22:27:12Z","timestamp":1789165632177,"version":"build-2803163510"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2018,9,23]],"date-time":"2018-09-23T00:00:00Z","timestamp":1537660800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Limited data exist pertaining to outcomes following surgery for recurrent Rathke's cleft cysts (RCC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine treatment outcomes in patients undergoing reoperation for recurrent or residual RCCs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of 112 consecutive RCC operations in 109 patients between 1995 and 2017 was conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighteen patients underwent 21 RCC reoperations with a mean follow-up of 58 mo. Patient symptoms prior to reoperation included headaches (14, 66.7%) and vision loss (12, 57.1%). Thirteen of 18 patients (72.2%) required hormone supplementation prior to reoperation including 5 with diabetes insipidus (DI). Mean RCC diameter was 16 mm and 76% had suprasellar extension. Compared to index RCC cases, intraoperative cerebrospinal fluid leak repair was more common in reoperation cases (15\/21, 71% vs 43\/91, 47%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.05). There was 1 carotid artery injury without neurological sequelae, and 2 postoperative cerebrospinal fluid (CSF) leaks (9.5%). Rates of transient hyponatremia (3\/10, 30% vs 4\/91, 4.4%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.04) and transient DI (5\/10, 50% vs 17\/91, 18.7%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.04) were higher in the reoperation vs index group. Improved headaches and vision were reported in 4\/12 (33%) and 8\/12 (61.5%) of RCC reoperation patients, respectively. Two patients developed new permanent DI. A higher proportion of reoperation patients had RCC squamous metaplasia (24% vs 5.4%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0=\u00a0.02) or wall inflammation (42.9% vs 2.2%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0&lt;\u00a0.001) on pathological examination.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Reoperation for RCCs is generally safe at tertiary pituitary centers and often results in improved vision. Hypopituitarism is less likely to improve following reoperation for recurrent RCCs. Several histopathological features may help characterize \u201catypical RCCs\u201d with a higher likelihood of recurrence\/progression.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opy258","type":"journal-article","created":{"date-parts":[[2018,9,22]],"date-time":"2018-09-22T21:32:04Z","timestamp":1537651924000},"page":"675-684","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":26,"title":["Recurrent Rathke's Cleft Cysts: Incidence and Surgical Management in a Tertiary Pituitary Center over 2 Decades"],"prefix":"10.1227","volume":"16","author":[{"given":"Michelle A","family":"Wedemeyer","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9342-4221","authenticated-orcid":false,"given":"Michelle","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vance L","family":"Fredrickson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anush","family":"Arakelyan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Bradley","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A","family":"Donoho","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle M","family":"Hurth","sequence":"additional","affiliation":[{"name":"Division of Pathology, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin H","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D","family":"Carmichael","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Diabetes, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"},{"name":"Division of Endocrinology and Diabetes, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,6]]},"reference":[{"issue":"1","key":"bib1-20240909","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1148\/radiology.193.1.8090885","article-title":"Incidental pituitary lesions in 1,000 unselected autopsy specimens","volume":"193","author":"Teramoto","year":"1994","journal-title":"Radiology"},{"issue":"1-2","key":"bib2-20240909","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1007\/BF00685342","article-title":"Electron-microscopical study of a Rathke's cleft cyst","volume":"60","author":"Diengdoh","year":"1983","journal-title":"Acta Neuropathol"},{"issue":"6","key":"bib3-20240909","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.3171\/jns.1994.80.6.1018","article-title":"Epithelial cystic lesions of the sellar and parasellar region: a continuum of ectodermal derivatives?","volume":"80","author":"Harrison","year":"1994","journal-title":"J Neurosurg"},{"issue":"3","key":"bib4-20240909","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/0090-3019(88)90272-8","article-title":"Epithelial cells in symptomatic Rathke's cleft cysts","volume":"30","author":"Matsushima","year":"1988","journal-title":"Surg Neurol"},{"issue":"7","key":"bib5-20240909","first-page":"2357","article-title":"Clinical, radiological and pathological features of patients with Rathke's cleft cysts: tumors that may recur","volume":"82","author":"Mukherjee","year":"1997","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"bib6-20240909","doi-asserted-by":"crossref","first-page":"E4","DOI":"10.3171\/2010.2.FOCUS09318","article-title":"Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships","volume":"28","author":"Zada","year":"2010","journal-title":"Neurosurg Focus"},{"issue":"2","key":"bib7-20240909","doi-asserted-by":"crossref","first-page":"189","DOI":"10.3171\/jns.2005.102.2.0189","article-title":"Surgical outcomes in 118 patients with Rathke cleft cysts","volume":"102","author":"Aho","year":"2005","journal-title":"J Neurosurg"},{"issue":"4","key":"bib8-20240909","doi-asserted-by":"crossref","first-page":"577","DOI":"10.3171\/jns.2004.101.4.0577","article-title":"Surgery for Rathke cleft cysts: technical considerations and outcomes","volume":"101","author":"Benveniste","year":"2004","journal-title":"J Neurosurg"},{"issue":"1","key":"bib9-20240909","doi-asserted-by":"crossref","first-page":"33","DOI":"10.3171\/jns.2004.100.1.0033","article-title":"Surgical treatment of symptomatic Rathke cleft cysts: clinical features and results with special attention to recurrence","volume":"100","author":"Kim","year":"2004","journal-title":"J Neurosurg"},{"issue":"2","key":"bib10-20240909","doi-asserted-by":"crossref","first-page":"310","DOI":"10.3171\/2010.7.JNS091793","article-title":"Transsphenoidal resection of 82 Rathke cleft cysts: limited value of alcohol cauterization in reducing recurrence rates","volume":"114","author":"Lillehei","year":"2011","journal-title":"J Neurosurg"},{"issue":"12","key":"bib11-20240909","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1007\/s00701-011-1072-8","article-title":"Prognostic factors of operated Rathke's cleft cysts with special reference to re-accumulation and recommended surgical strategy","volume":"153","author":"Ogawa","year":"2011","journal-title":"Acta Neurochir"},{"issue":"11","key":"bib12-20240909","first-page":"3972","article-title":"Cystic lesions of the pituitary: clinicopathological features distinguishing craniopharyngioma, Rathke's cleft cyst, and arachnoid cyst","volume":"84","author":"Shin","year":"1999","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"bib13-20240909","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.crad.2006.12.001","article-title":"Pituitary adenoma, craniopharyngioma, and Rathke cleft cyst involving both intrasellar and suprasellar regions: differentiation using MRI","volume":"62","author":"Choi","year":"2007","journal-title":"Clin Radiol"},{"issue":"1","key":"bib14-20240909","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s11102-015-0675-0","article-title":"Extended transsphenoidal approach for pituitary adenomas invading the cavernous sinus using multiple complementary techniques","volume":"19","author":"Bao","year":"2016","journal-title":"Pituitary"},{"issue":"2","key":"bib15-20240909","doi-asserted-by":"crossref","first-page":"418","DOI":"10.3171\/2016.1.JNS152238","article-title":"Endonasal endoscopic reoperation for residual or recurrent craniopharyngiomas","volume":"126","author":"Dhandapani","year":"2017","journal-title":"J Neurosurg"},{"issue":"3","key":"bib16-20240909","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s11102-010-0221-z","article-title":"Long term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas","volume":"13","author":"Chang","year":"2010","journal-title":"Pituitary"},{"issue":"3","key":"bib17-20240909","doi-asserted-by":"crossref","first-page":"459","DOI":"10.3171\/jns.1994.81.3.0459","article-title":"Reversible visual deficit following debulking of a Rathke's cleft cyst: a tethered chiasm?","volume":"81","author":"Fischer","year":"1994","journal-title":"J Neurosurg"},{"key":"bib18-20240909","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.wneu.2015.10.073","article-title":"Bony regeneration of the sella after transsphenoidal pituitary surgery","volume":"88","author":"Yahia-Cherif","year":"2016","journal-title":"World Neurosurg"},{"issue":"1","key":"bib19-20240909","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s10143-007-0098-0","article-title":"The role of the endoscope in the transsphenoidal management of cystic lesions of the sellar region","volume":"31","author":"Cavallo","year":"2007","journal-title":"Neurosurg Rev"},{"issue":"1","key":"bib20-20240909","doi-asserted-by":"crossref","first-page":"E2","DOI":"10.3171\/2011.5.FOCUS1175","article-title":"Symptomatic Rathke cleft cysts: extent of resection and surgical complications","volume":"31","author":"Higgins","year":"2011","journal-title":"Neurosurg Focus"},{"issue":"5","key":"bib21-20240909","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.wneu.2011.12.091","article-title":"Symptomatic Rathke cleft cyst: clinical features and surgical outcomes","volume":"78","author":"Kim","year":"2012","journal-title":"World Neurosurg"},{"issue":"4","key":"bib22-20240909","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1007\/s12022-014-9328-5","article-title":"Spontaneous alteration from Rathke's cleft cyst to craniopharyngioma-possible involvement of transformation between these pathologies","volume":"25","author":"Ogawa","year":"2014","journal-title":"Endocr Pathol"},{"issue":"2-3","key":"bib23-20240909","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.wneu.2010.06.027","article-title":"Transsphenoidal surgery for craniopharyngiomas: the lessons of experience, timing, and restraint","volume":"74","author":"Zada","year":"2010","journal-title":"World Neurosurg"},{"issue":"1","key":"bib24-20240909","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/0090-3019(95)00144-1","article-title":"The pathologic, surgical, and MR spectrum of Rathke cleft cysts","volume":"44","author":"Kleinschmidt-DeMasters","year":"1995","journal-title":"Surg Neurol"},{"issue":"1","key":"bib25-20240909","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3171\/2014.3.JNS131532","article-title":"Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations","volume":"121","author":"Jahangiri","year":"2014","journal-title":"J Neurosurg"},{"issue":"3","key":"bib26-20240909","doi-asserted-by":"crossref","first-page":"227","DOI":"10.3171\/2012.10.PEDS12160","article-title":"Endoscopic endonasal skull base surgery in the pediatric population","volume":"11","author":"Chivukula","year":"2013","journal-title":"J Neurosurg Pediatr"},{"issue":"6","key":"bib27-20240909","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.3171\/2009.10.JNS09348","article-title":"Endoscopic endonasal resection of Rathke cleft cysts: clinical outcomes and surgical nuances","volume":"112","author":"Madhok","year":"2010","journal-title":"J Neurosurg"},{"issue":"3","key":"bib28-20240909","doi-asserted-by":"crossref","first-page":"448","DOI":"10.3171\/jns.2005.103.3.0448","article-title":"Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients","volume":"103","author":"Nemergut","year":"2005","journal-title":"J Neurosurg"},{"issue":"3","key":"bib29-20240909","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1227\/01.NEU.0000374768.16291.03","article-title":"Endocrinopathy, vision, headache, and recurrence after transsphenoidal surgery for Rathke cleft cysts","volume":"67","author":"Wait","year":"2010","journal-title":"Neurosurgery"},{"issue":"6","key":"bib30-20240909","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.jocn.2010.10.014","article-title":"Endoscopic endonasal resection of symptomatic Rathke cleft cysts","volume":"18","author":"Xie","year":"2011","journal-title":"J Clin Neurosci"},{"issue":"1","key":"bib31-20240909","doi-asserted-by":"crossref","first-page":"77","DOI":"10.3171\/jns.1966.24.1.0077","article-title":"Intrasellar epithelial cysts","volume":"24","author":"Fager","year":"1966","journal-title":"J Neurosurg"},{"issue":"1","key":"bib32-20240909","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1227\/01.NEU.0000144824.80046.1F","article-title":"Transsphenoidal endoscopic approach in the treatment of Rathke's cleft cyst","volume":"56","author":"Frank","year":"2005","journal-title":"Neurosurgery"},{"issue":"2","key":"bib33-20240909","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1227\/00006123-199202000-00004","article-title":"Radiologic characteristics and results of surgical management of Rathke's cysts in 43 patients","volume":"30","author":"Ross","year":"1992","journal-title":"Neurosurgery"},{"issue":"3","key":"bib34-20240909","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/BF00688754","article-title":"Ciliated and goblet cells in craniopharyngioma. Light and electron microscopic studies at surgery and autopsy","volume":"50","author":"Matsushima","year":"1980","journal-title":"Acta Neuropathol"},{"issue":"8","key":"bib35-20240909","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1136\/jnnp-2012-303194","article-title":"Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: A systematic review and meta-analysis","volume":"84","author":"Ammirati","year":"2013","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"6","key":"bib36-20240909","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.3171\/2009.10.JNS091265","article-title":"A Rathke cleft cyst to craniopharyngioma: is there a spectrum?","volume":"112","author":"Wolfe","year":"2010","journal-title":"J Neurosurg"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/article-pdf\/16\/6\/675\/30215037\/opy258.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/01787389-201906000-00004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:50:13Z","timestamp":1786121413000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01787389-201906000-00004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,22]]},"references-count":36,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opy258","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,22]]},"assertion":[{"value":"2018-03-16","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-08-07","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}