Headache Resolution After Rathke Cleft Cyst Resection: A Meta-Analysis

• Published in: World neurosurgery 2018-03, Vol.111, p.e764-e772
• Main Authors: Altuwaijri, Njoud, Cote, David J., Lamba, Nayan, Albenayan, Walaa, Ren, Steven P., Zaghloul, Iman, Doucette, Joanne, Zaidi, Hasan A., Mekary, Rania A., Smith, Timothy R.
• Format: Article
• Language: English
• Subjects: Headache resolution; Meta-analysis; Rathke cleft cyst; Resection
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.12.170

Rathke cleft cysts (RCC) are benign lesions of the sella that often present with headache. It is not currently well established whether surgical resection of RCC results in resolution of headache. We conducted a meta-analysis to examine the effect of RCC resection on headache resolution. PubMed, EMBASE, and Cochrane databases were searched through June 2017 for articles that evaluated the effect of RCC resection on headache resolution. Pooled effect estimates were calculated using fixed-effects and random-effects models. Ten case series with 276 patients were included. Transsphenoidal surgery (TSS) was used to resect RCC in all of the studies. Only 1 patient in 1 study underwent transcranial surgery. Using the fixed effect model, the overall headache resolution prevalence was 71.7% (95% confidence interval [CI] 65.3%, 77.3%) among patients who underwent resection of RCC (I2 = 76.9%; P-heterogeneity < 0.01). Subgroup analysis based on center (P-interaction < 0.01) and continent (P < 0.01) showed a higher resolution in studies conducted in a single center (79.8%; 95% CI 73.7%, 84.8%) than in multiple centers (40.0%; 95% CI 26.9%, 54.8%) and a higher resolution in studies conducted in Asia (85.0%) than in Europe (61.5%) or North America (65.7%). Metaregression analysis was significant on mean follow-up time (slope = 0.03; P = 0.02), percentage of women (slope −0.05; P < 0.01), journal impact factor (slope 0.73; P < 0.01), and study quality (slope −0.99; P < 0.01) but not on mean age (P = 0.10). None of the above-mentioned results were significant when the random effects model was used. No evidence of publication bias was observed. This meta-analysis demonstrates that the resection of RCC in patients presenting with headache is associated with headache resolution. •Transsphenoidal surgery (TSS) is first-line for symptomatic Rathke cleft cysts (RCC).•Headache is a common and debilitating symptom for patients with RCC.•TSS is associated with headache resolution in patients undergoing TSS.