Abstract: Objective : To discuss the diagnosis and treatment of surgery of Rathke's cleft cysts. Methods : 41 cases of Rathke's cleft cysts who were treated by microsurgery and diagnosed throughpathological results were reviewed. 16 of them were male and 25 were female. Mean age were 32.8years old. Duration of symptoms were 20.6 months in average. The main clinical manifestation includedheadache(63.4%), pituitary dysfunction(56.1%) and visual interference(31.7%). Computed Tomographyand Magnetic Resonance Imaging showed cystic mass in the area of sella turcica. 39 cases were treatedby transsphenoidal microsurgery and 2 cases were treated through craniotomy. In the operation, thecontent of the cysts were moved and drainaged, the cyst wall were partially moved and keeped opening. Results : Before the operation, only 7 cases were correctly diagnosed. In the follow-up period from 3months to 8 years, symptom of headache were all resolved(26/26), pituitary dysfunction were resolved in56.5%(13/23) and visual interference in 76.9%(10/13). No patient recurred. Conclusions : It is difficultto establish the correct diagnosis of Rathke's cleft cysts before operation. The Magnetic ResonanceImaging signal was multiple and nonspecific. Transsphenoidal microsurgery can prove the diagnosis, re-solve the symptoms, is the effective way to treat the Rathke's cleft cysts.