Craniopharyngioma and Rathke’s cleft cysts

Both craniopharyngiomas and Rathke’s cysts are rare pituitary lesions of dysembryogenic origin. Their radiological differentiation may be sometimes difficult due to their occasionally similar imaging characteristics. The surgical management of these lesions, especially of craniopharyngiomas, may be very challenging. Gross total removal of a craniopharyngioma is associated with longer recurrence-free survival but could be associated with higher rate of surgery-related morbidities and pituitary insufficiency. Craniopharyngiomas are considered in the majority of cases to be a ‘chronic disease’. A principle difference in the operative management of these two lesions is that in craniopharyngiomas, resection of their thicker capsule is mandatory in order to achieve complete removal, whereas it is nearly impossible and not recommended to attempt such cyst wall removal in Rathke’s cysts. Emptying of the cyst content is usually sufficient to provide cure in the majority of these patients. Recurrences in Rathke’s cyst are only rarely observed in contrast to craniopharyngiomas.