Kinoshita Yasuyuki, Taguchi Akira, Yamasaki Fumiyuki, Tominaga Atsushi, Arita Kazunori, Horie Nobutaka
1Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima.
2Department of Neurosurgery and Neuro-Endovascular Therapy, Hiroshima Prefectural Hospital, Hiroshima; and.
J Neurosurg. 2022 Sep 2;138(5):1426-1432. doi: 10.3171/2022.7.JNS22716. Print 2023 May 1.
Rathke's cleft cysts (RCCs) are relatively common and often detected incidentally. They are usually asymptomatic and managed conservatively. However, little is known about their natural history. Thus, the authors aimed to examine the natural course of RCCs and identify the risk factors for their progression.
This retrospective study examined 229 patients (median age 43.0 years) diagnosed with RCCs by MRI and followed up without surgery (median period 36.6 months). The median cyst height on the initial MRI was 10 mm. Progression or regression of RCC was defined as cyst height changes of ≥ 1 mm.
In total, 23 (10.0%) RCCs progressed, whereas 73 (31.9%) RCCs spontaneously regressed. The remaining 133 were noted to be stable throughout the follow-up period. Patients with progressed RCCs were significantly older than those with stable RCCs. In patients with acute headache as an initial symptom, RCCs were significantly more likely to spontaneously regress. New symptoms occurred in 6 patients, 5 of whom underwent surgery for RCC progression. Of these 6 patients, 1 patient had persistent adrenocorticotropic hormone deficiency and 1 patient developed diabetes insipidus. Kaplan-Meier analysis results showed RCC progression and new symptom development rates to be 12.0% and 4.1% at 5 years and 13.7% and 5.7% at 10 years, respectively.
RCCs rarely progress or cause new symptoms in the long term. Patients with asymptomatic RCC should be followed up for at least 5 years to ensure RCC inactivity. RCCs in older adults may require greater surveillance.
拉克氏裂囊肿（RCCs）相对常见，常为偶然发现。它们通常无症状，采用保守治疗。然而，对其自然病程了解甚少。因此，作者旨在研究RCCs的自然病程并确定其进展的危险因素。
这项回顾性研究检查了229例经MRI诊断为RCCs且未接受手术随访的患者（中位年龄43.0岁）（中位随访期36.6个月）。初始MRI上囊肿的中位高度为10mm。RCC的进展或消退定义为囊肿高度变化≥1mm。
总共有23例（10.0%）RCCs进展，而73例（31.9%）RCCs自发消退。其余133例在整个随访期内保持稳定。进展的RCCs患者比稳定的RCCs患者年龄显著更大。以急性头痛为初始症状的患者中，RCCs自发消退的可能性显著更高。6例患者出现新症状，其中5例因RCC进展接受了手术。在这6例患者中，1例患有持续性促肾上腺皮质激素缺乏症，1例患了尿崩症。Kaplan-Meier分析结果显示，5年时RCC进展率和新症状发生率分别为12.0%和4.1%，10年时分别为13.7%和5.7%。
RCCs长期很少进展或引起新症状。无症状RCC患者应随访至少5年以确保RCC无活动。老年患者的RCC可能需要更密切的监测。
