Case Report Pediatr Neurosurg 2000;33:159–161 Rathke’s Cleft Cyst Abscess Zvi H. Israel a Mufid Yacoub a John M. Gomori b Shlomo Dotan c Yakov Fellig d Yigal Shoshan a Sergei Spektor e Departments of a Neurosurgery, b Neuroradiology, c Neuro-Opthalmology, and d Neuropathology, Hadassah University Hospital, Jerusalem, and e Department of Neurosurgery, Ichilov Hospital, Tel Aviv, Israel Received: April 3, 2000 Accepted: July 19, 2000 Zvi H. Israel, BSc, MBBS Department of Neurosurgery, Oregon Health Sciences University 3181 SW Sam Jackson Park Road Portland, OR 97201 (USA) Tel. +1 503 494 9000, E-Mail israel@ohsu.edu ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2000 S. Karger AG, Basel 1016–2291/00/0333–0159$17.50/0 Accessible online at: www.karger.com/journals/pne Key Words Rathke’s cleft cyst W Pituitary W Abscess Abstract Pituitary abscesses are rare. Occasionally they will arise in pre-existing pituitary pathology. We report such an occurrence within a Rathke’s cleft cyst. On the basis of history and imaging, this was indistinguishable from more commonly encountered pituitary pathology. Copyright © 2000 S. Karger AG, Basel Introduction Rathke’s cleft cyst (RCC) was first described by Lush- ka in 1860 [11]. They have been found to occur in up to 33% of normal pituitary glands at routine autopsy [2]. This lesion has been reported more frequently since the advent of MR imaging [8, 14], however, they are usually small and asymptomatic. Infection and abscess formation within a RCC is a very rare occurrence and the subject of occasional case reports only [1, 7, 13]. Case Report A 13-year-old girl was admitted to our neurosurgical service with a 7-month history of deteriorating vision. Prior medical history was unremarkable, specifically there had been no recent febrile illness. Menarche had been at the age of 11 years and she had not experi- enced any menstrual irregularities prior to admission. On examina- tion the patient was alert and appeared generally well. She was afe- brile and there were no signs of meningeal irritation. Visual field evaluation revealed a bitemporal hemianopsia and there was evi- dence of left optic neuropathy on fundoscopy. Laboratory investigations including a full blood count and differ- ential white count, blood and urinary electrolytes, endocrine profile including thyroid functions (T 3 , T 4 , TSH), cortisol, prolactin and growth hormone were all normal. Chest X-ray was reported as normal. The paranasal and sphenoid sinuses as seen on cranial CT appeared normal. Cranial CT demonstrated a noncalcified, sellar and suprasel- lar cystic lesion which underwent ring enhancement after injection of intravenous contrast. MR imaging (fig. 1) of the pituitary axis showed the same finding. Preoperative differential diagnosis was between a craniopharyngioma and a symptomatic RCC. With induction of general anesthesia the patient received routine antibiotic prophylaxis (dicloxacillin 1.5 g + gentamycin 80 mg). The lesion was approached subfrontally via a right craniotomy. A large bulging cystic lesion, pale rose in color, was identified. This pushed the chiasm upward and the optic nerves laterally. The cyst contents, consisting of 1.5 cm 3 of purulent fluid, were initially aspirated via a 23-gauge needle. The capsule was thick and stiff, but not adherent to the optic nerves or carotid arteries. The border of the normal pitu- itary could not be identified. Frozen section of the cyst capsule