Spontaneous Regression of Rathke's Cleft Cysts: A Report of Three Cases

Herein, we present 3 cases of Rathke's cleft cysts that shrank spontaneously within a short period. In addition, we present a literature review, discussing the characteristics and of action mechanisms of rapid Rathke's cleft cyst regression. Case 1 was that in a 17-year-old boy diagnosed with an Rathke's cleft cyst on the basis of magnetic resonance imaging. The Rathke's cleft cysts had expanded to compress the optical chiasm. Therefore, surgical intervention was planned. However, without any medical treatment, magnetic resonance imaging performed 3 months later revealed a spontaneous reduction in size, and surgery was canceled. Case 2 was in a 10-year-old boy who presented with a severe headache. Surgery was planned for a sellar cystic lesion; however, magnetic resonance imaging performed 2 months later revealed spontaneous shrinkage without any treatment. The patient's symptoms disappeared, and the surgery was canceled. Case 3 was in a 25-year-old man who presented with a headache. Magnetic resonance imaging at presentation revealed a cystic lesion in the sella turcica, but repeat magnetic resonance imaging 4 months later revealed spontaneous shrinkage. Fifty-nine cases of spontaneously shrinking Rathke's cleft cysts, initially characterized by severe headache (54.2%), have been reported; of these, 57% of cases were in patients younger than 39 years. Furthermore, 64% of patients showed evidence of cyst reduction on magnetic resonance imaging within 6 months. Type 1-weighted magnetic resonance imaging scans showed isointensity or high signal intensity in 91% of cases. In conclusion, spontaneous shrinkage of Rathke's cleft cysts can occur within a few months. Type 1-weighted images are characterized by high signal intensity, and episodic headaches may indicate shrinkage. The possibility of short-term regression of Rathke's cleft cyst should be considered before scheduled surgery.