2025 Proffered Presentations
S098: RATHKE CLEFT CYSTS: THE IMPACT OF AGE ON PATIENT CHARACTERISTICS, MANAGEMENT, AND SURGICAL OUTCOMES
Zain Peeran1; Poojan Shukla1; Robert Osorio2; Aarav Badani2; Aymen Kabir1; Abraham Dada1; Harmon Khela2; Mulki Mehari1; Tej Tummala2; Mikias Negussie1; Austin Lui2; Rithvik Ramesh1; Hunter Yamada1; Christian Jimenez1; Akhil Rajidi1; Manish K Aghi2; 1School of Medicine, University of California San Francisco, San Francisco, CA, USA; 2Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
Introduction: Rathke Cleft Cysts (RCCs) are benign cystic growths of the sellar region that are mostly diagnosed in patients above the age of 30 and often require surgery for endocrine dysfunction or mass effect symptoms such as headache and visual problems. Age-based differences in RCC presentation and surgical outcomes are not well understood and of particular interest, as RCCs evolve from remnants of Rathke’s pouch, an embryological structure, which may have age-specific implications. This study aims to delineate age-based differences in the clinical characteristics and postoperative outcomes of patients with RCCs.
Methods: The medical records of 484 patients (72% female) diagnosed with RCCs on imaging at a single institution were retrospectively reviewed. Continuous variables were analyzed via Kruskal-Wallis tests and categorical variables via Fisher or Chi-square tests.
Results: Patients were divided into 3 cohorts based on age at diagnosis: <30 (median (SD) age = 23.8 (4.6) years) vs. 30-65 (45.0 (9.8) years) vs. >65 (71.3 (6.4) years) (Table 1, Figure 1A). Hispanic or Latino ethnicity was more common in patients <30 (31%) followed by patients 30-65 (13%) then patients >65 (10%) (p<0.001). Median (SD) RCC size was largest in patients >65 (11.0 (5.7) mm) followed by patients <30 (8.5 (5.2) mm) then patients 30-65 (8.0 (5.7) mm) (p=0.006, Figure 1B). Among patients who underwent surgery, preoperative headache was more common in patients <30 (86%) followed by patients 30-65 (73%), and least common in patients >65 (63%) (p=0.021, Table 2). Preoperative hyperprolactinemia followed a similar pattern for surgical patients, being most common in patients <30 (29%), followed by patients 30-65 (16%), and least common in patients >65 (8.7%) (p=0.023). Among surgical patients, other preoperative endocrine dysfunction was more common in patients >65 (67%), followed by patients 30-65 (39%), and least common in patients <30 (34%) (p<0.001). Rates of surgery did not differ for patients <30 vs. 30-65 vs. >65 (53% vs. 44% vs. 57%, p= 0.068, Figure 1C). Among surgical patients, patients <30 were more likely to be female (85%) than patients 30-65 (67%) and >65 (67%) (p=0.031). Postoperatively, residual cyst was more common in patients <30 (41%) than in patients 30-65 (24%) and >65 (24%) (p=0.043, Table 3, Figure 1D). Postoperatively, headache was more likely to improve in patients >65 (61%), followed by patients <30 (47%), and least likely in patients 30-65 (45%) (p<0.001). Rates of postoperative improvement in other symptoms, endocrine dysfunction, and diabetes insipidus did not differ across age groups.
Conclusion: Rates of surgery for patients with RCCs did not differ by age. Patients >65 years old were more likely to present with larger RCCs, while postoperative residual cyst was more common in patients <30. Although preoperative headache was least common in patients >65 years old, the >65 age group was more likely to experience improvement in headache postoperatively. Further studies are warranted to interrogate these age-related differences and determine which symptoms and imaging findings in older patients predict surgical benefit.
