{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:51:09Z","timestamp":1777661469826,"version":"3.51.4"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Rathke cleft cysts (RCCs) are sellar lesions that are commonly encountered in adults but infrequently diagnosed in the pediatric population. As a result, the optimal management of pediatric RCCs remains a subject of controversy. Only 2 prior surgical series have been published on pediatric RCCs and no study has compared the presentation and outcomes of surgically versus conservatively managed cases. The authors therefore performed a comparative analysis of pediatric cases of RCC in which patients were treated with surgery or managed in a conservative manner.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>All cases involving pediatric patients diagnosed with an RCC at the University of Virginia between 2000 and 2016 were included in this study. Patient medical records, operative notes, and neuroimaging findings were reviewed. Patients who developed visual field deficits, radiographic evidence of chiasmal compression, or medically refractory headaches were considered candidates for surgical intervention. All patients who were selected for surgery underwent an endoscopic endonasal approach with cyst fenestration.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>A total of 24 pediatric patients were diagnosed with an RCC over a 16-year period. Seven patients ultimately underwent transsphenoidal cyst fenestration, and 17 were managed conservatively. The patients\u2019 age at diagnosis, cyst size, and pituitary function at the time of RCC diagnosis were similar in the conservatively and surgically managed cohorts. At diagnosis, 19 of 24 patients endorsed headaches that led to neuroimaging. All patients in the surgical cohort endorsed severe headaches at diagnosis compared with 71% in the conservative group. For the 7 patients treated with surgery, complete cyst evacuation was achieved in 86% of cases. Transient postoperative endocrinopathy occurred in 4 (57%) of 7 surgically treated individuals and resolved in all cases. In the conservative cohort, 1 patient developed a delayed pituitary-related endocrinopathy. Headache resolution occurred in 5 (71%) of the 7 patients who underwent surgery and 7 (58%) of the 12 who were treated without surgery. Cyst recurrence was documented in 1 individual in the surgical cohort who underwent a subtotal cyst fenestration that ultimately required re-intervention. In the conservative cohort, spontaneous cyst shrinkage occurred in 35% of patients with a median time to regression of 23.5 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Pediatric RCCs are benign sellar lesions that often present with headaches. While cyst fenestration mitigates headaches in most patients, the majority of conservatively managed pediatric patients with RCCs will have spontaneous headache resolution. Furthermore, spontaneous RCC regression occurs in a substantial number of individuals. Thus, in the absence of optic compression, visual field deficit, or diagnostic uncertainty, many pediatric cases of RCC can be managed conservatively.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.9.peds17400","type":"journal-article","created":{"date-parts":[[2017,12,22]],"date-time":"2017-12-22T14:56:29Z","timestamp":1513954589000},"page":"308-314","source":"Crossref","is-referenced-by-count":21,"title":["Presentation and outcomes in surgically and conservatively managed pediatric Rathke cleft cysts"],"prefix":"10.3171","volume":"21","author":[{"given":"Matthew J.","family":"Shepard","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed A.","family":"Elzoghby","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Department of Neurosurgery, Ain Shams University, Cairo, Egypt"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin N.","family":"Kiehna","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children Hospital, Los Angeles, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Spencer C.","family":"Payne","sequence":"additional","affiliation":[{"name":"Otolaryngology, University of Virginia Health System, Charlottesville, Virginia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John A.","family":"Jane","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg","doi-asserted-by":"publisher","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 CJ","year":"2005","unstructured":"Aho CJ, Liu C, Zelman V, Couldwell WT, Weiss MH: Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg 102:189\u2013193, 200510.3171\/jns.2005.102.2.018915739543"},{"key":"b2","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.3171\/2009.10.JNS091070","article-title":"Spontaneous involution of Rathke cleft cysts: is it rare or just underreported?","volume":"112","author":"Amhaz HH","year":"2010","unstructured":"Amhaz HH, Chamoun RB, Waguespack SG, Shah K, McCutcheon IE: Spontaneous involution of Rathke cleft cysts: is it rare or just underreported? J Neurosurg 112:1327\u20131332, 20101992919910.3171\/2009.10.JNS091070"},{"key":"b3","series-title":"Pediatr Radiol","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1007\/BF02012389","article-title":"MRI in seven cases of Rathke\u2019s cleft cyst in infants and children","volume":"23","author":"Christophe C","year":"1993","unstructured":"Christophe C, Flamant-Durand J, Hanquinet S, Heinrichs C, Raftopoulos C, Sariban E, : MRI in seven cases of Rathke\u2019s cleft cyst in infants and children. Pediatr Radiol 23:79\u201382, 199310.1007\/BF020123898516048"},{"key":"b4","series-title":"J Clin Endocrinol Metab","doi-asserted-by":"publisher","first-page":"3943","DOI":"10.1210\/jc.2015-2604","article-title":"a case for conservative management: characterizing the natural history of radiographically diagnosed Rathke cleft cysts","volume":"100","author":"Culver SA","year":"2015","unstructured":"Culver SA, Grober Y, Ornan DA, Patrie JT, Oldfield EH, Jane JA Jr, : a case for conservative management: characterizing the natural history of radiographically diagnosed Rathke cleft cysts. J Clin Endocrinol Metab 100:3943\u20133948, 201510.1210\/jc.2015-260426305621"},{"key":"b5","series-title":"Eur J Endocrinol","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1530\/EJE-14-1029","article-title":"Hydrocephalus and hypothalamic involvement in pediatric patients with craniopharyngioma or cysts of Rathke\u2019s pouch: impact on long-term prognosis","volume":"172","author":"Daubenb\u00fcchel AM","year":"2015","unstructured":"Daubenb\u00fcchel AM, Hoffmann A, Gebhardt U, Warmuth-Metz M, Sterkenburg AS, M\u00fcller HL: Hydrocephalus and hypothalamic involvement in pediatric patients with craniopharyngioma or cysts of Rathke\u2019s pouch: impact on long-term prognosis. Eur J Endocrinol 172:561\u2013569, 201510.1530\/EJE-14-102925650403"},{"key":"b6","series-title":"J Pediatr Endocrinol Metab","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1515\/jpem.2010.087","article-title":"Rathke cleft cyst in seven-year-old girl presenting with central diabetes insipidus and review of literature","volume":"23","author":"Evliyaoglu O","year":"2010","unstructured":"Evliyaoglu O, Evliyaoglu C, Ayva S: Rathke cleft cyst in seven-year-old girl presenting with central diabetes insipidus and review of literature. J Pediatr Endocrinol Metab 23:525\u2013529, 20102066235510.1515\/jpem.2010.087"},{"key":"b7","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"77","DOI":"10.3171\/jns.1966.24.1.0077","article-title":"Intrasellar epithelial cysts","volume":"24","author":"Fager CA","year":"1966","unstructured":"Fager CA, Carter H: Intrasellar epithelial cysts. J Neurosurg 24:77\u201381, 1966590330010.3171\/jns.1966.24.1.0077"},{"key":"b8","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1469","DOI":"10.1007\/s00381-008-0710-9","article-title":"Combined endoscopic and microscopic management of pediatric pituitary region tumors through one nostril: technical note with case illustrations","volume":"24","author":"Frazier JL","year":"2008","unstructured":"Frazier JL, Chaichana K, Jallo GI, Qui\u00f1ones-Hinojosa A: Combined endoscopic and microscopic management of pediatric pituitary region tumors through one nostril: technical note with case illustrations. Childs Nerv Syst 24:1469\u20131478, 200810.1007\/s00381-008-0710-918769925"},{"key":"b9","series-title":"J Neurooncol","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1007\/s11060-013-1272-6","article-title":"Rathke\u2019s cleft cysts: review of natural history and surgical outcomes","volume":"117","author":"Han SJ","year":"2014","unstructured":"Han SJ, Rolston JD, Jahangiri A, Aghi MK: Rathke\u2019s cleft cysts: review of natural history and surgical outcomes. J Neurooncol 117:197\u2013203, 201410.1007\/s11060-013-1272-624146189"},{"key":"b10","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1625","DOI":"10.1007\/s00381-016-3160-9","article-title":"Pediatric symptomatic Rathke cleft cyst compared with cystic craniopharyngioma","volume":"32","author":"Hayashi Y","year":"2016","unstructured":"Hayashi Y, Kita D, Fukui I, Sasagawa Y, Oishi M, Okajima M, : Pediatric symptomatic Rathke cleft cyst compared with cystic craniopharyngioma. Childs Nerv Syst 32:1625\u20131632, 20162739244810.1007\/s00381-016-3160-9"},{"key":"b11","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1159\/000071321","article-title":"Transsphenoidal microsurgery for pediatric craniopharyngioma: special considerations regarding indications and method","volume":"39","author":"Im SH","year":"2003","unstructured":"Im SH, Wang KC, Kim SK, Chung YN, Kim HS, Lee CH, : Transsphenoidal microsurgery for pediatric craniopharyngioma: special considerations regarding indications and method. Pediatr Neurosurg 39:97\u2013103, 20031284520010.1159\/000071321"},{"key":"b12","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1159\/000028997","article-title":"Rathke\u2019s cleft cyst abscess","volume":"33","author":"Israel ZH","year":"2000","unstructured":"Israel ZH, Yacoub M, Gomori JM, Dotan S, Fellig Y, Shoshan Y, : Rathke\u2019s cleft cyst abscess. Pediatr Neurosurg 33:159\u2013161, 200010.1159\/00002899711096363"},{"issue":"1","key":"b13","series-title":"Neurosurg Focus","doi-asserted-by":"publisher","first-page":"E3","DOI":"10.3171\/2011.5.FOCUS1178","article-title":"Rathke cleft cysts in pediatric patients: presentation, surgical management, and postoperative outcomes","volume":"31","author":"Jahangiri A","year":"2011","unstructured":"Jahangiri A, Molinaro AM, Tarapore PE, Blevins L Jr, Auguste KI, Gupta N, : Rathke cleft cysts in pediatric patients: presentation, surgical management, and postoperative outcomes. Neurosurg Focus 31(1):E3, 201110.3171\/2011.5.FOCUS117821721868"},{"key":"b14","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1097\/00006123-200208000-00025","article-title":"Pituitary surgery: transsphenoidal approach","volume":"51","author":"Jane JA Jr","year":"2002","unstructured":"Jane JA Jr, Thapar K, Kaptain GJ, Maartens N, Laws ER Jr: Pituitary surgery: transsphenoidal approach. Neurosurgery 51:435\u2013444, 20021218278210.1097\/00006123-200208000-00025"},{"key":"b15","series-title":"J Pediatr Endocrinol Metab","doi-asserted-by":"publisher","first-page":"1175","DOI":"10.1515\/jpem.2010.184","article-title":"Rathke\u2019s cleft cysts in children and adolescents: association with female puberty","volume":"23","author":"Katavetin P","year":"2010","unstructured":"Katavetin P, Cheunsuchon P, Grant E, Boepple PA, Hedley-Whyte ET, Misra M, : Rathke\u2019s cleft cysts in children and adolescents: association with female puberty. J Pediatr Endocrinol Metab 23:1175\u20131180, 201010.1515\/jpem.2010.18421284332"},{"key":"b16","series-title":"J Neurosurg","doi-asserted-by":"publisher","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 JE","year":"2004","unstructured":"Kim JE, Kim JH, Kim OL, Paek SH, Kim DG, Chi JG, : Surgical treatment of symptomatic Rathke cleft cysts: clinical features and results with special attention to recurrence. J Neurosurg 100:33\u201340, 20041474390910.3171\/jns.2004.100.1.0033"},{"key":"b17","series-title":"Korean J Pediatr","doi-asserted-by":"publisher","first-page":"759","DOI":"10.3345\/kjp.2010.53.7.759","article-title":"Risk factor for pituitary dysfunction in children and adolescents with Rathke\u2019s cleft cysts","volume":"53","author":"Lim HH","year":"2010","unstructured":"Lim HH, Yang SW: Risk factor for pituitary dysfunction in children and adolescents with Rathke\u2019s cleft cysts. Korean J Pediatr 53:759\u2013765, 20102118995210.3345\/kjp.2010.53.7.759"},{"key":"b18","series-title":"Int J Pediatr Otorhinolaryngol","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1016\/j.ijporl.2010.08.009","article-title":"Endoscopic endonasal transsphenoidal surgery for sellar tumors in children","volume":"74","author":"Locatelli D","year":"2010","unstructured":"Locatelli D, Massimi L, Rigante M, Custodi V, Paludetti G, Castelnuovo P, : Endoscopic endonasal transsphenoidal surgery for sellar tumors in children. Int J Pediatr Otorhinolaryngol 74:1298\u20131302, 201010.1016\/j.ijporl.2010.08.00920828839"},{"key":"b19","series-title":"Ann Pediatr Endocrinol Metab","doi-asserted-by":"publisher","first-page":"20","DOI":"10.6065\/apem.2014.19.1.20","article-title":"Clinical and radiological findings of incidental Rathke\u2019s cleft cysts in children and adolescents","volume":"19","author":"Oh YJ","year":"2014","unstructured":"Oh YJ, Park HK, Yang S, Song JH, Hwang IT: Clinical and radiological findings of incidental Rathke\u2019s cleft cysts in children and adolescents. Ann Pediatr Endocrinol Metab 19:20\u201326, 201410.6065\/apem.2014.19.1.2024926459"},{"key":"b20","series-title":"AJNR Am J Neuroradiol","doi-asserted-by":"publisher","first-page":"1866","DOI":"10.3174\/ajnr.A4387","article-title":"Differentiation between cystic pituitary adenomas and Rathke cleft cysts: a diagnostic model using MRI","volume":"36","author":"Park M","year":"2015","unstructured":"Park M, Lee SK, Choi J, Kim SH, Kim SH, Shin NY, : Differentiation between cystic pituitary adenomas and Rathke cleft cysts: a diagnostic model using MRI. AJNR Am J Neuroradiol 36:1866\u20131873, 20152625143610.3174\/ajnr.A4387"},{"key":"b21","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1227\/00006123-199202000-00004","article-title":"Radiologic characteristics and results of surgical management of Rathke\u2019s cysts in 43 patients","volume":"30","author":"Ross DA","year":"1992","unstructured":"Ross DA, Norman D, Wilson CB: Radiologic characteristics and results of surgical management of Rathke\u2019s cysts in 43 patients. Neurosurgery 30:173\u2013179, 1992154588410.1227\/00006123-199202000-00004"},{"key":"b22","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1007\/s003810050391","article-title":"Rathke\u2019s cleft cyst as a cause of growth hormone deficiency and micropenis","volume":"15","author":"Setian N","year":"1999","unstructured":"Setian N, Aguiar CH, Galv\u00e3o JA, Crivellaro CE, Dichtchekenian V, Damiani D: Rathke\u2019s cleft cyst as a cause of growth hormone deficiency and micropenis. Childs Nerv Syst 15:271\u2013273, 199910.1007\/s00381005039110392501"},{"key":"b23","series-title":"AJNR Am J Neuroradiol","first-page":"2144","article-title":"Pituitary cysts in childhood evaluated by MR imaging","volume":"26","author":"Takanashi J","year":"2005","unstructured":"Takanashi J, Tada H, Barkovich AJ, Saeki N, Kohno Y: Pituitary cysts in childhood evaluated by MR imaging. AJNR Am J Neuroradiol 26:2144\u20132147, 200516155173"},{"key":"b24","series-title":"Radiology","doi-asserted-by":"publisher","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 A","year":"1994","unstructured":"Teramoto A, Hirakawa K, Sanno N, Osamura Y: Incidental pituitary lesions in 1,000 unselected autopsy specimens. Radiology 193:161\u2013164, 199410.1148\/radiology.193.1.80908858090885"},{"key":"b25","series-title":"Radiographics","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1148\/radiographics.7.2.3448641","article-title":"Pediatric case of the day. Rathke\u2019s cleft cyst","volume":"7","author":"Towbin RB","year":"1987","unstructured":"Towbin RB, Ball WS, Kaufman RA: Pediatric case of the day. Rathke\u2019s cleft cyst. Radiographics 7:385\u2013388, 198710.1148\/radiographics.7.2.34486413448641"},{"key":"b26","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"535","DOI":"10.3171\/jns.1991.74.4.0535","article-title":"Clinical, radiographic, and pathological features of symptomatic Rathke\u2019s cleft cysts","volume":"74","author":"Voelker JL","year":"1991","unstructured":"Voelker JL, Campbell RL, Muller J: Clinical, radiographic, and pathological features of symptomatic Rathke\u2019s cleft cysts. J Neurosurg 74:535\u2013544, 1991200236610.3171\/jns.1991.74.4.0535"},{"key":"b27","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"451","DOI":"10.3171\/jns.1977.47.3.0451","article-title":"Symptomatic Rathke\u2019s cleft cyst. Morphological study with light and electron microscopy and tissue culture","volume":"47","author":"Yoshida J","year":"1977","unstructured":"Yoshida J, Kobayashi T, Kageyama N, Kanzaki M: Symptomatic Rathke\u2019s cleft cyst. Morphological study with light and electron microscopy and tissue culture. J Neurosurg 47:451\u2013458, 197710.3171\/jns.1977.47.3.0451894347"},{"key":"b28","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1227\/01.NEU.0000341873.20737.56","article-title":"Surgical treatment of Rathke cleft cysts in children","volume":"64","author":"Zada G","year":"2009","unstructured":"Zada G, Ditty B, McNatt SA, McComb JG, Krieger MD: Surgical treatment of Rathke cleft cysts in children. Neurosurgery 64:1132\u20131138, 20091948789310.1227\/01.NEU.0000341873.20737.56"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/21\/3\/article-p308.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/21\/3\/article-p308.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/21\/3\/article-p308.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T13:46:32Z","timestamp":1681566392000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/21\/3\/article-p308.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3]]},"references-count":28,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2017.9.peds17400","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3]]}}}