{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:02:26Z","timestamp":1786125746728,"version":"build-2736575974"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2019,8,26]],"date-time":"2019-08-26T00:00:00Z","timestamp":1566777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To review a series of hemorrhagic RCCs for physicians encountering this rare presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A database review of\u00a0&gt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>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\u00a0=\u00a01). Endocrine disturbances at presentation included pre-existing amenorrhea in all female patients (3\/3), hypothyroidism (n\u00a0=\u00a02), panhypopituitarism (n\u00a0=\u00a02), 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opz239","type":"journal-article","created":{"date-parts":[[2019,8,26]],"date-time":"2019-08-26T20:44:36Z","timestamp":1566852276000},"page":"470-479","source":"Crossref","is-referenced-by-count":8,"title":["Hemorrhagic Presentation of Rathke Cleft Cysts: A Surgical Case Series"],"prefix":"10.1227","volume":"18","author":[{"given":"Lauren","family":"Schooner","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"},{"name":"Department of Endocrinology, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle A","family":"Wedemeyer","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"},{"name":"Department of Endocrinology, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip A","family":"Bonney","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"},{"name":"Department of Endocrinology, 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"},{"name":"Department of Endocrinology, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Hurth","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"},{"name":"Department of Endocrinology, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Mathew","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"},{"name":"Department of Endocrinology, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C Jason","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"},{"name":"Department of Endocrinology, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Shiroishi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"},{"name":"Department of Endocrinology, 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":"Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, California"},{"name":"Department of Endocrinology, 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"},{"name":"Department of Endocrinology, 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":"Department of Endocrinology, University of Southern California Keck School of Medicine, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,5]]},"reference":[{"issue":"2","key":"bib1-20231016","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s11060-013-1272-6","article-title":"Rathke's cleft cysts: review of natural history and surgical outcomes","volume":"117","author":"Han","year":"2014","journal-title":"J Neurooncol"},{"issue":"4","key":"bib2-20231016","doi-asserted-by":"crossref","first-page":"535","DOI":"10.3171\/jns.1991.74.4.0535","article-title":"Clinical, radiographic, and pathological features of symptomatic Rathke's cleft cysts","volume":"74","author":"Voelker","year":"1991","journal-title":"J Neurosurg"},{"issue":"1","key":"bib3-20231016","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 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Neurosurg"},{"issue":"4","key":"bib10-20231016","doi-asserted-by":"crossref","first-page":"803","DOI":"10.3171\/2014.12.JNS141083","article-title":"Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification","volume":"122","author":"Knosp","year":"2015","journal-title":"J Neurosurg"},{"issue":"2","key":"bib11-20231016","doi-asserted-by":"crossref","first-page":"318","DOI":"10.3171\/2010.5.JNS091905","article-title":"Rathke cleft cyst apoplexy: a newly characterized distinct clinical entity","volume":"114","author":"Chaiban","year":"2011","journal-title":"J Neurosurg"},{"issue":"3","key":"bib12-20231016","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1590\/2359-3997000000047","article-title":"Pituitary apoplexy: pathophysiology, diagnosis and management","volume":"59","author":"Glezer","year":"2015","journal-title":"Arch Endocrinol 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