{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:56:41Z","timestamp":1790855801835,"version":"4.1.0"},"reference-count":28,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Rathke\u2019s cleft cysts (RCCs) are non-neoplastic and rare sellar lesions derived from remnants of Rathke\u2019s pouch. While asymptomatic RCCs often require only conservative management, symptomatic cases may necessitate surgical intervention. The aim of our study is to investigate the correlations between clinical, radiological and histological features of RCCs to propose a novel management model. Methods: We conducted a retrospective analysis from patients who underwent surgery for cystic lesions between 2013 and 2023 in the Neurosurgery Department of Treviso Hospital (Italy) using for our purpose only those confirmed by histological specimen as RCCs. Results: 20 patients for a total of 24 procedures (20 primary surgeries\/4 cases for recurrence) were performed for RCCs. A gross total resection was achieved in 23 cases, resulting in improvement of headache and visual symptoms in all patients. Hyperintensity on T1-weighted MRI sequences is more strongly correlated with inflammation and with intralesional metaplasia (p = 0.009). Both characteristics are involved in the development of hypopituitarism (p = 0.057), headache, and visual impairment (p = 0.082) compared to cysts with CSF-like content, even when the latter are smaller in size (p = 0.078). Discussion and Conclusions: RCCs are rare lesions whose management is challenging due to a lack of established guidelines. Intraoperative cystic content and MRI cystic characteristics seem to correlate with clinical presentation and long-term outcome in these patients. The transsphenoidal endoscopic approach is a safe and effective treatment, especially in cysts with inflammatory aspect in histopathological specimens and in dedicated MRI sequences that could take advantage of an early surgical resection. A decision-making model based on clinical, radiological and histopathological features of cysts could be useful to guide RCCs\u2019 treatment, underlining the role of inflammation that seems to be involved in the onset of visual and hormonal impairment and in recurrence risk.<\/jats:p>","DOI":"10.3390\/diagnostics15070886","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T16:26:31Z","timestamp":1743611191000},"page":"886","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Data-Driven Approach for Rathke\u2019s Cleft Cysts Management"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9978-5041","authenticated-orcid":false,"given":"Alberto","family":"D\u2019Amico","sequence":"first","affiliation":[{"name":"Academic Neurosurgery, Department of Neurosciences, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Cappelletti","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, AULSS2 Marca Trevigiana, Treviso Hospital, 31100 Treviso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Bresolin","sequence":"additional","affiliation":[{"name":"Academic Neurosurgery, Department of Neurosciences, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabetta","family":"Marton","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, AULSS2 Marca Trevigiana, Treviso Hospital, 31100 Treviso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2529-6149","authenticated-orcid":false,"given":"Luca","family":"Denaro","sequence":"additional","affiliation":[{"name":"Academic Neurosurgery, Department of Neurosciences, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6286-4750","authenticated-orcid":false,"given":"Giuseppe","family":"Canova","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, AULSS2 Marca Trevigiana, Treviso Hospital, 31100 Treviso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1111\/j.1365-2265.2011.04235.x","article-title":"Rathke\u2019s cleft cysts","volume":"76","author":"Trifanescu","year":"2012","journal-title":"Clin. Endocrinol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1093\/neuros\/nyy285","article-title":"Intratumoral Rathke\u2019s Cleft Cyst Remnants Within Craniopharyngioma, Pituitary Adenoma, Suprasellar Dermoid, and Epidermoid Cysts: A Ubiquitous Signature of Ectodermal Lineage or a Transitional Entity?","volume":"85","author":"Manjila","year":"2019","journal-title":"Neurosurgery"},{"key":"ref_3","doi-asserted-by":"crossref","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","year":"2015","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1111\/cen.13744","article-title":"Natural history of Rathke\u2019s cleft cysts: A retrospective analysis of a two centres experience","volume":"89","author":"Sala","year":"2018","journal-title":"Clin. Endocrinol."},{"key":"ref_5","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"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1007\/s007010050482","article-title":"MRI findings and clinical manifestations in Rathke\u2019s cleft cyst","volume":"141","author":"Saeki","year":"1999","journal-title":"Acta Neurochir."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1111\/j.1365-2265.2006.02446.x","article-title":"Magnetic resonance imaging, clinical manifestations, and management of Rathke\u2019s cleft cyst","volume":"64","author":"Nishioka","year":"2006","journal-title":"Clin. Endocrinol."},{"key":"ref_8","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."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1097\/00006123-199801000-00003","article-title":"Transsphenoidal management of 28 symptomatic Rathke\u2019s cleft cysts, with special reference to visual and hormonal recovery","volume":"42","author":"Powell","year":"1998","journal-title":"Neurosurgery"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.neuchi.2020.12.010","article-title":"Surgery versus conservative care for Rathke\u2019s cleft cyst","volume":"67","author":"Truong","year":"2021","journal-title":"Neurochirurgie"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1111\/j.1526-4610.2006.00539.x","article-title":"Headaches associated with Rathke\u2019s cleft cyst","volume":"46","author":"Nishioka","year":"2006","journal-title":"Headache"},{"key":"ref_12","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."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Solari, D., Cavallo, L.M., Somma, T., Chiaramonte, C., Esposito, F., Del Basso De Caro, M., and Cappabianca, P. (2015). Endoscopic Endonasal Approach in the Management of Rathke\u2019s Cleft Cysts. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0139609"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.3171\/2014.12.JNS14596","article-title":"Characteristics of Rathke\u2019s cleft cyst based on cyst location with a primary focus on recurrence after resection","volume":"122","author":"Chotai","year":"2015","journal-title":"J. Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e282","DOI":"10.1016\/j.wneu.2022.01.118","article-title":"Long-Term Outcomes of Endoscopic Cyst Fenestration for Rathke Cleft Cyst","volume":"161","author":"Yamada","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1053\/j.sult.2004.10.001","article-title":"Management of pituitary incidentalomas: According to a survey of pituitary incidentalomas in Japan","volume":"26","author":"Oyama","year":"2005","journal-title":"Semin. Ultrasound CT MR"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e208","DOI":"10.1016\/j.wneu.2019.08.196","article-title":"Clinicopathologic Characteristics and Endoscopic Surgical Outcomes of Symptomatic Rathke\u2019s Cleft Cysts","volume":"132","author":"Cabuk","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/s11604-024-01641-0","article-title":"Comparison of clinical and radiological characteristics of inflammatory and non-inflammatory Rathke cleft cysts","volume":"43","author":"Matsushita","year":"2025","journal-title":"Jpn. J. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"59","DOI":"10.14791\/btrt.2022.0036","article-title":"MRI-Based Classification of Rathke\u2019s Cleft Cyst and Its Clinical Implication","volume":"11","author":"Kim","year":"2023","journal-title":"Brain Tumor Res. Treat."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s11154-025-09949-6","article-title":"Rathke\u2019s cleft cyst: From history to molecular genetics","volume":"26","author":"Hacioglu","year":"2025","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Ijare, O.B., Sharpe, M.A., Baskin, D.S., and Pichumani, K. (2020). Proton Magnetic Resonance Spectroscopy Characterization of Rathke\u2019s Cleft Cysts (RCCs): Relevance to the Differential Diagnosis of Pituitary Adenomas and RCCs. Cancers, 12.","DOI":"10.3390\/cancers12020360"},{"key":"ref_22","first-page":"611","article-title":"MRI and pathological features of Rathke cleft cysts in the sellar region","volume":"19","author":"Wang","year":"2020","journal-title":"Exp. Ther. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1055\/s-0036-1585088","article-title":"Treatment Outcomes of Rathke\u2019s Cleft Cysts Managed with Marsupialization","volume":"78","author":"Kuan","year":"2017","journal-title":"J. Neurol. Surg. B Skull Base"},{"key":"ref_24","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\u2019s cleft cyst","volume":"56","author":"Frank","year":"2005","journal-title":"Neurosurgery"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/s00701-024-06299-1","article-title":"Growth dynamics of Rathke\u2019s Cleft cyst: A risk score system for surgical decision making","volume":"166","author":"Alsavaf","year":"2024","journal-title":"Acta Neurochir."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"123757","DOI":"10.1016\/j.wneu.2025.123757","article-title":"Surgical Strategies Regarding the Extended Endoscopic Transnasal Approach for Isolated Suprasellar Rathke\u2019s Cleft Cysts","volume":"195","author":"Emengen","year":"2025","journal-title":"World Neurosurg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1007\/s00701-020-04237-5","article-title":"Rathke\u2019s cleft cysts following transsphenoidal surgery: Long-term outcomes and development of an optimal follow-up strategy","volume":"162","author":"Marcus","year":"2020","journal-title":"Acta Neurochir."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Qian, A., Zhou, J., Zhang, X., Yu, J., and Wang, X. (2023). Incidence and factors associated with the recurrence of Rathke\u2019s cleft cyst after surgery: A systematic review and meta-analysis. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.1065316"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/7\/886\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:07:31Z","timestamp":1760029651000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/7\/886"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":28,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["diagnostics15070886"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15070886","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,1]]}}}