Kondziolka Douglas, Bernstein Kenneth, Lee Cheng-Chia, Yang Huai-Che, Liscak Roman, May Jaromir, Martínez-Álvarez Roberto, Martínez-Moreno Nuria, Bunevicius Adomas, Sheehan Jason P
Departments of1Neurosurgery and.
2Radiation Oncology, New York University Langone Medical Center, New York, New York.
J Neurosurg. 2022 Feb 11;137(4):1041-1046. doi: 10.3171/2021.12.JNS212108. Print 2022 Oct 1.
Rathke's cleft cysts (RCCs) are sellar collections from an incompletely regressed Rathke's pouch. Common symptoms of RCCs can include headaches, visual loss, and endocrinopathy. Surgery is required in some cases of symptomatic or growing RCCs. Recurrence after surgery is common (range 10%-40%). Stereotactic radiosurgery (SRS) has been used in an attempt to control growth and symptoms, but outcomes are not well known. The authors sought to study the outcomes of RCCs following Gamma Knife surgery for both salvage and initial treatment.
The outcomes of 25 patients with RCCs who underwent SRS between 2001 and 2020 were reviewed. Four patients received initial SRS and 21 were treated with salvage SRS. Diagnosis was based on imaging or histopathology. Cyst control was defined as stability or regression of the cyst. Kaplan-Meier analysis was used to determine time to recurrence and determine potential factors for recurrence.
The respective median clinical follow-up and margin dose were 6.5 years and 12 Gy. Overall control was achieved in 19 (76%) of 25 patients, and 4 recurrences required further intervention. The average time to recurrence was 35.6 months in those RCCs that recurred. Visual recovery occurred in 14 (93.3%) of 15 patients and no new post-SRS visual deficits occurred. The presence of a pretreatment visual deficit was often an indicator of RCC regrowth. All 3 patients with pretreatment hyperprolactinemia experienced resolution after SRS. New endocrinopathy related to SRS was noted in 5 (20%) of 25 patients, all of which were thyroid and/or cortisol axis related. Upfront SRS was used in 4 patients. No new endocrinopathies or visual deficits developed after upfront SRS, and the 1 patient with a pretreatment visual deficit recovered. One of the 4 patients with upfront SRS experienced a recurrence after 7.5 years.
SRS produced effective recovery of visual deficits and carries a low risk for new visual deficits. Cyst control was achieved in approximately three-fourths of the patients. Following SRS, patients without pretreatment visual deficits are less likely to have RCC regrowth. Endocrinopathy can occur after SRS, similar to other sellar mass lesions. Initial SRS shows the potential for long-term cyst control, with improvement of symptoms and a low risk for complications.
拉克氏囊肿（RCCs）是来自未完全退化的拉克氏囊的鞍区肿物。RCCs的常见症状可包括头痛、视力丧失和内分泌病。一些有症状或不断增大的RCCs病例需要进行手术。手术后复发很常见（范围为10%-40%）。立体定向放射外科（SRS）已被用于试图控制囊肿生长和症状，但结果尚不清楚。作者试图研究伽玛刀手术后RCCs的治疗结果，包括挽救性治疗和初始治疗。
回顾了2001年至2020年间接受SRS治疗的25例RCCs患者的治疗结果。4例患者接受了初始SRS治疗，21例接受了挽救性SRS治疗。诊断基于影像学或组织病理学。囊肿控制定义为囊肿稳定或缩小。采用Kaplan-Meier分析来确定复发时间并确定复发的潜在因素。
临床随访的中位数和边缘剂量分别为6.5年和12 Gy。25例患者中有19例（76%）实现了总体控制，4例复发患者需要进一步干预。复发的RCCs的平均复发时间为35.6个月。15例患者中有14例（93.3%）视力恢复，且SRS后未出现新的视力缺陷。治疗前存在视力缺陷通常是RCCs复发的一个指标。3例治疗前高泌乳素血症患者在SRS后均症状缓解。25例患者中有5例（20%）出现了与SRS相关的新发内分泌病，均与甲状腺和/或皮质醇轴有关。4例患者采用了初始SRS治疗。初始SRS治疗后未出现新的内分泌病或视力缺陷，1例治疗前有视力缺陷的患者视力恢复。4例接受初始SRS治疗的患者中有1例在7.5年后复发。
SRS能有效恢复视力缺陷，且出现新的视力缺陷的风险较低。约四分之三的患者实现了囊肿控制。SRS治疗后，治疗前无视力缺陷的患者RCCs复发的可能性较小。与其他鞍区肿物病变类似，SRS后可能会出现内分泌病。初始SRS显示出长期控制囊肿的潜力，症状改善且并发症风险较低。
