Clinical characteristics and long-term outcome in patients with Rathke’s cleft cysts associated with headache

This study aimed to investigate the clinical features and long-term outcomes of patients with Rathke’s cleft cysts (RCCs) presenting with headaches. A retrospective analysis was conducted on 51 patients who underwent transsphenoidal surgery for RCCs between 2009 and 2022. Patients were divided into headache (n = 27) and non-headache (n = 24) groups. Clinical data, MRI findings, and surgical outcomes were analyzed. Headache improvement was assessed using a 5-point postoperative scale. Patients in the headache group were significantly younger (40 vs. 48 year: p < 0.05), had less visual disturbance (7% vs. 63%: p < 0.01) and had smaller cysts (10 mm vs. 17 mm: p < 0.01). MRI showed a higher prevalence of T1 hyper intense (74% vs. 46%: p < 0.05) and intracystic nodules (62% vs. 25%: p < 0.05) in the headache group. Multivariate analysis identified less visual disturbance (p < 0.01) and smaller cyst (p < 0.01) as independent predictors of headache presence. Postoperative follow-up (mean: 5.3 years) revealed that 66% of patients experienced headache resolution or improvement, while 34% reported persistent or recurrent symptoms. Resolution or improvement after surgery correlated with less frequent use of analgesics and specific headache characteristics (frontal/retro-orbital location). In patients with RCCs, larger cyst size does not necessarily correlate with the presence of headache, indicating that factors such as inflammation may contribute to symptom development. Surgical intervention offers sustained relief in many cases, though long-term outcomes vary. Further research is needed to clarify mechanisms and optimize treatment strategies.