Ophthalmic Manifestations of Rathke's Cleft Cysts

We studied the neuro-ophthalmic features of patients with symptomatic Rathke's cleft cysts, to distinguish features of Rathke's cleft cysts from those of craniopharyngioma. Eleven patients who had undergone surgery for symptomatic Rathke's cleft cysts in the Liverpool University Department of Neurological Science were identified from the records. Histopathologic analyses, clinical notes, and radiologic investigations were reviewed. Eight of the 11 patients initially had visual problems. Reduced visual acuity, visual field defect, or both, were detected in nine patients. Optic atrophy was observed in eight patients. Other initial features included headaches, epilepsy, and endocrine disturbance. All patients recovered from surgery, and an improvement in the visual acuity or visual field defect was noted in six patients. Symptomatic Rathke's cleft cysts often manifest as visual disturbance. Every effort to distinguish Rathke's cleft cysts from craniopharyngiomas should be made preoperatively. Rathke's cleft cysts only require limited surgical intervention, and radiotherapy is not necessary. Early recognition and treatment can lead to improvement in visual function.