Infected rathke cleft cysts

Distinguishing factors and factors predicting recurrence

Matthew C. Tate, Arman Jahangiri, Lewis Blevins, Sandeep Kunwar, Manish K. Aghi

Research output: Contribution to journalReview article

22 Citations (Scopus)

Abstract

Background: Rathke cleft cysts (RCCs) are benign sellar lesions that are generally asymptomatic but sometimes warrant transsphenoidal drainage. Small case reports have described infected RCCs, but this phenomenon remains uncharacterized. Objective: We reviewed RCCs over 23 years at our institution to determine factors predicting infection and recurrence. Methods: We retrospectively reviewed the magnetic resonance images, laboratory results, microbiology, and pathology of 176 RCC patients (1985-2008) who underwent initial operation at our institution (n = 170) or at another institution followed by recurrence managed at our institution (n = 6). Results: There were 3 RCC categories: cysts cultured intraoperatively during initial surgery (n = 21), cysts not cultured during initial surgery but cultured during subsequent surgery (n = 9), and cysts that were never cultured (n = 146). Cultured cysts were larger (1.6 vs 1.2 cm; P =.002) and had more frequent pituitary dysfunction (76% vs 30%; P <.001) than noncultured cysts. Restricted diffusion was also more common in cultured cysts (50% vs 0%; P =.02). Of cysts cultured at initial or subsequent surgery, 48% and 44%, respectively, had positive cultures (n = 14) and were treated with antibiotics. The most common organisms were Staphylococcus epidermidis (64%) and Propionibacterium acnes (57%). Kaplan-Meier recurrence rates were 13% (culture positive/antibiotic treated), 31% (culture negative/not antibiotic treated), and 9% (noncultured) (P =.002, cultured vs noncultured; P =.002, culture negative/not antibiotic treated vs non-cultured; P =.5 culture positive/antibiotic treated vs noncultured). Conclusion: Suspected RCC infection, regardless of culture results, is a strong predictor of recurrence and may warrant antibiotic treatment. With antibiotic treatment, the recurrence rate of infected RCC approaches that of noninfected cysts. The higher recurrence rates reported in other series may reflect underrecognition of occult infection.

Original languageEnglish (US)
Pages (from-to)762-769
Number of pages8
JournalNeurosurgery
Volume67
Issue number3
DOIs
StatePublished - Sep 1 2010

Fingerprint

Central Nervous System Cysts
Cysts
Recurrence
Anti-Bacterial Agents
Infection
Propionibacterium acnes
Staphylococcus epidermidis
Microbiology
Drainage
Magnetic Resonance Spectroscopy
Pathology

Keywords

  • Bacteria
  • Infection
  • Inflammation
  • Metaplasia
  • Pituitary
  • Rathke cyst
  • Recurrence

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Tate, Matthew C. ; Jahangiri, Arman ; Blevins, Lewis ; Kunwar, Sandeep ; Aghi, Manish K. / Infected rathke cleft cysts : Distinguishing factors and factors predicting recurrence. In: Neurosurgery. 2010 ; Vol. 67, No. 3. pp. 762-769.
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title = "Infected rathke cleft cysts: Distinguishing factors and factors predicting recurrence",
abstract = "Background: Rathke cleft cysts (RCCs) are benign sellar lesions that are generally asymptomatic but sometimes warrant transsphenoidal drainage. Small case reports have described infected RCCs, but this phenomenon remains uncharacterized. Objective: We reviewed RCCs over 23 years at our institution to determine factors predicting infection and recurrence. Methods: We retrospectively reviewed the magnetic resonance images, laboratory results, microbiology, and pathology of 176 RCC patients (1985-2008) who underwent initial operation at our institution (n = 170) or at another institution followed by recurrence managed at our institution (n = 6). Results: There were 3 RCC categories: cysts cultured intraoperatively during initial surgery (n = 21), cysts not cultured during initial surgery but cultured during subsequent surgery (n = 9), and cysts that were never cultured (n = 146). Cultured cysts were larger (1.6 vs 1.2 cm; P =.002) and had more frequent pituitary dysfunction (76{\%} vs 30{\%}; P <.001) than noncultured cysts. Restricted diffusion was also more common in cultured cysts (50{\%} vs 0{\%}; P =.02). Of cysts cultured at initial or subsequent surgery, 48{\%} and 44{\%}, respectively, had positive cultures (n = 14) and were treated with antibiotics. The most common organisms were Staphylococcus epidermidis (64{\%}) and Propionibacterium acnes (57{\%}). Kaplan-Meier recurrence rates were 13{\%} (culture positive/antibiotic treated), 31{\%} (culture negative/not antibiotic treated), and 9{\%} (noncultured) (P =.002, cultured vs noncultured; P =.002, culture negative/not antibiotic treated vs non-cultured; P =.5 culture positive/antibiotic treated vs noncultured). Conclusion: Suspected RCC infection, regardless of culture results, is a strong predictor of recurrence and may warrant antibiotic treatment. With antibiotic treatment, the recurrence rate of infected RCC approaches that of noninfected cysts. The higher recurrence rates reported in other series may reflect underrecognition of occult infection.",
keywords = "Bacteria, Infection, Inflammation, Metaplasia, Pituitary, Rathke cyst, Recurrence",
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Infected rathke cleft cysts : Distinguishing factors and factors predicting recurrence. / Tate, Matthew C.; Jahangiri, Arman; Blevins, Lewis; Kunwar, Sandeep; Aghi, Manish K.

In: Neurosurgery, Vol. 67, No. 3, 01.09.2010, p. 762-769.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Infected rathke cleft cysts

T2 - Distinguishing factors and factors predicting recurrence

AU - Tate, Matthew C.

AU - Jahangiri, Arman

AU - Blevins, Lewis

AU - Kunwar, Sandeep

AU - Aghi, Manish K.

PY - 2010/9/1

Y1 - 2010/9/1

N2 - Background: Rathke cleft cysts (RCCs) are benign sellar lesions that are generally asymptomatic but sometimes warrant transsphenoidal drainage. Small case reports have described infected RCCs, but this phenomenon remains uncharacterized. Objective: We reviewed RCCs over 23 years at our institution to determine factors predicting infection and recurrence. Methods: We retrospectively reviewed the magnetic resonance images, laboratory results, microbiology, and pathology of 176 RCC patients (1985-2008) who underwent initial operation at our institution (n = 170) or at another institution followed by recurrence managed at our institution (n = 6). Results: There were 3 RCC categories: cysts cultured intraoperatively during initial surgery (n = 21), cysts not cultured during initial surgery but cultured during subsequent surgery (n = 9), and cysts that were never cultured (n = 146). Cultured cysts were larger (1.6 vs 1.2 cm; P =.002) and had more frequent pituitary dysfunction (76% vs 30%; P <.001) than noncultured cysts. Restricted diffusion was also more common in cultured cysts (50% vs 0%; P =.02). Of cysts cultured at initial or subsequent surgery, 48% and 44%, respectively, had positive cultures (n = 14) and were treated with antibiotics. The most common organisms were Staphylococcus epidermidis (64%) and Propionibacterium acnes (57%). Kaplan-Meier recurrence rates were 13% (culture positive/antibiotic treated), 31% (culture negative/not antibiotic treated), and 9% (noncultured) (P =.002, cultured vs noncultured; P =.002, culture negative/not antibiotic treated vs non-cultured; P =.5 culture positive/antibiotic treated vs noncultured). Conclusion: Suspected RCC infection, regardless of culture results, is a strong predictor of recurrence and may warrant antibiotic treatment. With antibiotic treatment, the recurrence rate of infected RCC approaches that of noninfected cysts. The higher recurrence rates reported in other series may reflect underrecognition of occult infection.

AB - Background: Rathke cleft cysts (RCCs) are benign sellar lesions that are generally asymptomatic but sometimes warrant transsphenoidal drainage. Small case reports have described infected RCCs, but this phenomenon remains uncharacterized. Objective: We reviewed RCCs over 23 years at our institution to determine factors predicting infection and recurrence. Methods: We retrospectively reviewed the magnetic resonance images, laboratory results, microbiology, and pathology of 176 RCC patients (1985-2008) who underwent initial operation at our institution (n = 170) or at another institution followed by recurrence managed at our institution (n = 6). Results: There were 3 RCC categories: cysts cultured intraoperatively during initial surgery (n = 21), cysts not cultured during initial surgery but cultured during subsequent surgery (n = 9), and cysts that were never cultured (n = 146). Cultured cysts were larger (1.6 vs 1.2 cm; P =.002) and had more frequent pituitary dysfunction (76% vs 30%; P <.001) than noncultured cysts. Restricted diffusion was also more common in cultured cysts (50% vs 0%; P =.02). Of cysts cultured at initial or subsequent surgery, 48% and 44%, respectively, had positive cultures (n = 14) and were treated with antibiotics. The most common organisms were Staphylococcus epidermidis (64%) and Propionibacterium acnes (57%). Kaplan-Meier recurrence rates were 13% (culture positive/antibiotic treated), 31% (culture negative/not antibiotic treated), and 9% (noncultured) (P =.002, cultured vs noncultured; P =.002, culture negative/not antibiotic treated vs non-cultured; P =.5 culture positive/antibiotic treated vs noncultured). Conclusion: Suspected RCC infection, regardless of culture results, is a strong predictor of recurrence and may warrant antibiotic treatment. With antibiotic treatment, the recurrence rate of infected RCC approaches that of noninfected cysts. The higher recurrence rates reported in other series may reflect underrecognition of occult infection.

KW - Bacteria

KW - Infection

KW - Inflammation

KW - Metaplasia

KW - Pituitary

KW - Rathke cyst

KW - Recurrence

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DO - 10.1227/01.NEU.0000377017.53294.B5

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JF - Neurosurgery

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