Rathke’s Cleft Cysts

At Montefiore Einstein Otorhinolaryngology – Head and Neck Surgery, you can access exceptional care for Rathke’s cleft cysts. As a global leader in otorhinolaryngology and head and neck surgery, we are an academic-based, national and international referral site for the most complex and high-risk cases. For over a century, we have been at the forefront of innovation, research and clinical care for ear, nose and throat (ENT) and head and neck conditions.

Ranked in the top 1% of all hospitals in the nation for complex specialty care according to U.S. News & World Report, Montefiore Einstein continues to make advances in the diagnosis and treatment of ENT and head and neck conditions. Our multidisciplinary team of world-renowned specialists has pioneered many of the otorhinolaryngological techniques used today and is passionate about uncovering the latest diagnostic approaches and treatments that can improve outcomes.

At Montefiore Einstein Otorhinolaryngology – Head and Neck Surgery, you can expect compassionate, personalized, research-driven treatment plans that meet the highest standards for quality and safety. We are also one of the first and few centers in the nation to routinely offer incisionless transorbital neuroendoscopic surgery (TONES) for minimally invasive access to very complex skull/cranial base tumors through the eye while preserving the patient’s vision.

When you need Rathke’s cleft cyst care, turn to our dedicated multidisciplinary team for a personalized treatment plan.

Rathke’s cleft cysts are thought to result from the abnormal embryological development of Rathke’s pouch (a sac-like structure that commonly forms during fetal development). Usually, by the third or fourth week of gestation, Rathke’s pouch develops while the pituitary gland is forming. When the pituitary gland is completely formed, this pouch commonly regresses during the embryonic period. In some cases, however, the pouch doesn’t close completely, and a cyst can fill with fluid through the remaining opening or cleft.

Most patients with Rathke’s cleft cysts do not experience symptoms. In some cases, the cyst can become enlarged and compress surrounding structures, including the pituitary gland, optic chiasm (the area at the skull base where optic nerve fibers that connect the brain to one eye cross optic nerve fibers from the other eye) and adjacent neurovascular structures. This can lead to symptoms such as headache, visual disturbance or other neurological symptoms, as well as endocrinopathy (which can cause hormonal imbalances and affect growth and development, metabolism, sexual function and mood).

A Rathke’s cleft cyst can be diagnosed using a variety of tests, including:

• Advanced imaging: Magnetic resonance imaging (MRI) is often the imaging modality of choice to capture a detailed picture of the location, shape, signal intensity and MRI-enhanced characteristics of the lesion. In certain cases, computed tomography (CT) scans can also be useful for evaluating Rathke’s cleft cysts, particularly in assessing calcification.
• Blood tests: including endocrine lab studies to check levels of the hormones that may indicate whether the pituitary gland function is impacted
• Visual field testing: to assess for disturbances in vision, such as peripheral vision loss

Rathke’s cleft cysts are typically asymptomatic and can usually be monitored. In some patients who have symptoms, treatment may include surgery to drain, biopsy and/or remove (wholly or partially) the cyst and surrounding capsule. A variety of surgical approaches can be used, such as minimally invasive transsphenoidal surgery via microscopic or endoscopic endonasal approaches, transorbital neuroendoscopic surgery (TONES) and craniotomy.