Introduction: Rathke Cleft Cysts (RCCs) are benign sellar growths derived from remnants of Rathke’s pouch, an embryological structure, which may have age-specific implications. This study investigates how age affects RCC presentation and outcomes.
Methods: 545 patients diagnosed with RCCs on MRI were retrospectively reviewed. Continuous and categorical variables were analyzed via Kruskal-Wallis and Fisher or Chi-square tests respectively.
Results: Patients were divided into 3 groups based on age in years at diagnosis: < 30 (median=24.4, n=125) vs. 30-65 (median=45.1, n=338) vs. >65 (median=70.1, n=82). 72% of the cohort was female and sex did not differ by age group. Headache was the most common presenting symptom across all groups, with 79% of patients < 30, 69% of patients 30-65, and 50% of patients >65 reporting headache (p < 0.001). Rates of hyperprolactinemia were also highest among patients < 30 (22%) followed by patients 30-56 (15%) then patients >65 (5.1%) (p=0.004). 313 patients (57%) underwent surgery (50% fenestration, 33% gross total resection, 17% subtotal resection). Type of surgery (fenestration vs. resection) and extent of resection did not differ by age. Rates of surgery were higher in patients >65 (65%) and < 30 (64%) than in patients 30-65 (53%) (p=0.042). For surgical patients, median size at presentation differed by age, being higher in patients >65 (12mm) and patients < 30 (12.0mm) than in patients 30-65 (10.0mm) (p=0.048). Rates of postoperative headache improvement were highest in patients >65 (62%), followed by patients 30-65 (51%), and lowest in patients < 30 (42%) (p < 0.001).
Conclusion : Surgery rates varied by age group, with those over 65 having the highest prevalence. The >65 age group also reported the lowest incidence of preoperative headache but demonstrated the greatest likelihood of postoperative headache improvement. Additional research is justified to explore these age-related differences and identify symptoms and imaging findings that could predict surgical benefit.
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