OBJECTIVES Describe the outcomes of surgically conservative management of patients with Rathke’s cleft cysts. METHODS A retrospective case-series of patients with Rathke’s Cleft Cysts was performed. Patients were included if they had an enlarging or clinically symptomatic Rathke’s cyst managed via fenestration or marsupialsation. The primary outcome was recurrence of cystic component. Secondary outcomes were visual field change, headache, pituitary function and surgical complications. The radiologic characteristics of the Rathke’s cyst included size, location, septation, fluid-fluid levels and intracystic nodules. Associated hypophysitis and cyst consistency on histopathology was also assessed. RESULTS Thirty-seven patients were evaluated (age 46.6±18.6yrs) with 90% having a marsupialisation procedure. Patients presented visual deficit (28.5%), headache (59.5%), pituitary dysfunction (21.4%) and hypophysitis (38.1%). Recurrence occurred in 5.3%. Complications were low with infections (5.3%) and no hemorrhage or CSF leaks. Of those that complained of preoperative headache, all (100%) complained of post operative headache. CONCLUSION Marsupialisation of Rathke Cleft Cysts is a low morbidity intervention but should be reserved for patients with pituitary dysfunction and visual impairment rather than headache.