To explore the characteristics and risk factors of headaches associated with Rathke cleft cyst (RCC) and to provide evidence for evaluating the correlation between RCC and headaches preoperatively.

The clinical data of 30 patients, who were admitted to Department of Neurosurgery, the Second Affiliated Hospital of Dalian Medical University from January 2010 to December 2015 and diagnosed with RCC based on postoperative pathological examination, were collected and retrospectively analyzed. The patients were separated into 2 groups: a group of headaches associated with RCC (n=18) and a group of controls (n=12) based on the degrees of headache relief following surgical therapy. Clinical data of the two groups were statistically compared.

RCC-associated headaches were reported in the forehead (13 cases), temporal areas (3 cases) and both areas (2 cases). None of them presented with diffuse headache. Univariate analysis showed that there was no significant difference between the two groups in sex, age, family history, tumor volume and the signal intensity on T2-weighted MRI image (P>0.05). Pituitary dysfunction (P=0.009), hyper-intensity on T1-weighed MRI image (P=0.008), visual deficiency (P=0.024) and the ring-enhancement on MRI (P=0.008) had significant difference between the two groups. By means of multivariate logistic analysis, preoperative pituitary dysfunction (OR=0.069, P=0.046, 95% CI: 0.005-0.905) and ring-enhancement on MRI (OR=12.779, P=0.049, 95% CI: 1.010-161.691) were determined independent risk factors for headache associated with RCC.

Headaches associated with RCC appear to affect the forehead and temporal areas with complex mechanisms. Pituitary dysfunction and ring-enhancement on MRI may have close correlation with headache. Adequate preoperative evaluation could help improve the surgical effect.

Central nervous system cysts; Rathke’s cleft cyst; Headache; Microsurgery; Risk factors