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Allison Ferguson: Rathke's Cleft Cyst

She has long blonde hair that is partially pulled back. She wears a short sleeved orange dress. She is smiling.

The Challenge

Allison Ferguson was hard at work finishing her first semester as a high school senior.

She was busy with projects, exams, college applications, a part time job, and running on her school’s cross-country team. She unexpectedly began experiencing constant headaches, some which caused excruciating pain. Allison visited her doctor, who thought her headaches were caused by stress. He advised that nothing was wrong and that the headaches would eventually go away. Yet they continued and were getting worse.

"Now, she can do whatever she wants and is so excited to be going away to school and lead a normal life." — Allison's mother

Allison’s parents decided to seek the advice of a neurosurgeon in the family’s home town of Louisville, KY.

An MRI scan revealed a possible microadenoma (small benign tumor) on her pituitary gland. Allison’s neurosurgeon advised that the tumor was too small to have removed and did not think it was the cause of her headaches. Without answers, Allison continued to attend school despite having daily headaches. As time passed, her headaches continued to progress and became more frequent. Another visit to a neurosurgeon, followed by a neurologist, yielded no results.

A few months later, Allison went in for another MRI scan. This time, her doctors found something surprising. The lesion originally thought to be a microadenoma had grown into something more serious. Doctors diagnosed her with a Rathke cleft cyst, a rare type of cyst believed to originate from remnants of the Rathke pouch.

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During embryonic development, a Rathke pouch forms as a depression in the roof of the mouth, eventually losing its connection and rising to the pituitary gland. In Allison’s case, instead of naturally regressing, the pouch enlarged and formed into the cyst.

Allison’s doctors explained that as the cyst grew it placed pressure on the surrounding structures in her brain, which was causing her headaches. Because the cyst would continue to grow and cause further complications, it needed to be removed.

The Path to UPMC

One of Allison’s doctors advised her to consult with UPMC to learn more about a cutting-edge procedure being done to remove tumors through the nose. Allison’s mother, Tanis, turned to the Internet to learn more and discovered the Endoscopic Endonasal Approach (EEA) that was pioneered by UPMC surgeons. She sent Allison’s medical records to UPMC for review, and within a few days, the Fergusons had good news.

“The doctor called and said that Allison was an excellent candidate for EEA surgery and he was confident he could help her get back to normal,” explained Tanis.

Allison’s surgery was immediately scheduled and the Fergusons packed their bags for the trip to Pittsburgh.

The Solution

UPMC neurosurgeon Paul Gardner and otolaryngologist Carl Snyderman drained and removed most of the Rathke cleft cyst through Allison’s nose – using the EEA technique – immediately relieving the pressure from the surrounding structures of her brain. With this minimally invasive approach, surgeons were able to partially remove the lesion without disturbing Allison’s brain, blood vessels, or critical nerves. The small piece of the cyst was not removed in order to avoid damaging the pituitary gland.

The Results

A few days following the surgery, Allison was released from the hospital and she and her family returned home to Louisville. She rapidly bounced back to her everyday routine and is now headache free.

“My headaches went away right after I recovered from the surgery,” said Allison. “When I got home to Kentucky, everything was back to normal. I couldn’t believe it.”

Despite all that happened, Allison was able to finish high school and is now looking forward to attending the University of Kentucky, which is something her mother thought may not have happened.

“If you look at Allison, you would never know that she just had brain surgery,” she said. “When we first learned of her condition, we didn’t know what to expect. Now, she can do whatever she wants and is so excited to be going away to school and lead a normal life,” says Tanis. “I’ll miss her, but I know she’ll come visit.”

Our patient stories profile a number of patients who have had minimally invasive brain surgery at UPMC. Although everyone's care experience is unique, we hope that sharing these stories will help other prospective patients and their families better understand these procedures and their potential benefits.

Allison's treatment and results may not be representative of all similar cases.

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