Rathke's cleft cyst presenting as sphenoid sinusitis

Rathke's cleft cysts are developmental abnormalities of the craniopharyngea l duct composed of retained stratified ciliated cuboidal cells of the respi ratory type. Incidentally found in the pars intermedia in 13% to 33% of rou tine autopsies, they are discovered in growing numbers on CT and MRI scans. From 1991 to 1999, 9 cases of Rathke's cleft cysts were encountered by the senior authors, 4 of which were treated surgically (3 by using a transsphe noidal approach and one by using a transcranial subfrontal approach). Of th e 3 patients treated with a transsphenoidal approach, 2 presented with symp toms,mimicking sphenoid sinusitis and were initially referred for otolaryng ologic evaluation. The clinical, pathologic, and radiologic features, as we ll as management and follow-up of those 2 patients, are reviewed. There has been only one previous case report of Rathke's cleft cysts presenting as s inusitis, Nevertheless, the otolaryngologist should be aware of this condit ion because it may present with other significant symptomatic extracranial extensions.