Headache relief following endoscopic drainage of Rathke's cleft cyst.

Purpose: Headache is the most common presenting complaint in patients with Rathke's cleft cysts (RCC). The study aimed to assess the headache burden in patients undergoing endoscopic endonasal drainage of RCC.

Methods: In this longitudinal cohort study, a prospectively collected database of patients undergoing endoscopic endonasal drainage of RCC between 2017 and 2024 was analysed. The Headache Impact Test (HIT-6) and Anterior Skull Base questionnaire (ABSQ) were collected pre-operatively and at 3 weeks, 6 weeks, 3, 6 and 12 months from July 2020.

Results: 64 RCC patients were identified, 24 of whom had HIT-6 scores collected pre-operatively and at least one post-operative time point. 67% had a headache pre-operatively (HIT-6 > 36). Overall, HIT-6 score reduced by 5 points at 6 months (95% CI -0.3, -9.0, p = 0.04) compared to pre-operatively, adjusted for age. In patients with headache pre-operatively, HIT-6 reduced on average by 7 and 6 points respectively at 6 and 12 months (p < 0.05). No association was found with sex, pre-operative pituitary dysfunction, cyst location, size, MRI signal, histopathological characteristics or reoperation. Overall QOL decreased within the first 6 weeks postoperatively, but returned to baseline thereafter. A higher HIT-6 score was associated with worse ABSQ at 12 months (p = 0.01).

Conclusion: In the largest prospective study using a validated headache metric, endoscopic endonasal drainage of RCC may improve headache at 6 and 12 months post-operatively, providing long lasting relief. Surgery causes a transient worsening of QOL that resolves after 6 weeks. Headache burden directly correlated with QOL.