Rathke's cyst

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Rathke’s Cleft Cysts

Contents

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Pathophysiology

Rathke’s cleft cysts are benign, epithelium lined intrasellar cysts believed to arise from Rathke’s pouch. They’re more common in females and the mean age at presentation 38 years. Most are asymptomatic, but cysts may become symptomatic by compression of the optic apparatus, pituitary gland or stalk, or hypothalamus.

History

They are named after Martin Heinrich Rathke (1793-1860), an embryologist in Prussia. In 1838 described a diverticulum arising from the embryonic buccal cavity which became known as Rathke’s pouch.

Embryology

Rathke’s pouch arises Day 24, by the 5th week the neck of the pouch becomes occluded at the buccal-pharyngeal junction, and by the 6th week the pouch separates from the oral epithelium. The residual lumen of the pouch becomes a narrow Rathke’s cleft which usually regresses. Persistence or enlargement of the cleft is considered the cause of a Rathke’s Cleft Cyst.

Imaging

On MR Imaging, Rathke’s Cleft Cysts do not enlarge the sella. The have variable signal characteristics, and may have signal characteristics similar to CSF and may have high signal on T1 and variable signal on T2 secondary to muccopolysaccharides from mucin-secreting cells in the cyst wall. They exhibit variable enhancement.

Treatment

Symptomatic patients are generally treated via transsphenoidal surgery. Surgical complications include CSF rhinorrrhea, DI, and meningitis. Recurrence rates range from 5-33%.

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