鞍区良性占位病变MR视束水肿样变的研究

目的 研究视束水肿样变(OTE征)在鞍区良性占位病变的诊断学和治疗学意义.方法 207例初次确诊和手术病理证实的鞍区良性占位病变患者,肿瘤均接触或压迫视交叉和/或视束,其中垂体腺瘤116例、颅咽管瘤52例、鞍区脑膜瘤18例、囊肿性病变14例、垂体脓肿7例,回顾性分析MR上OTE征的影像学特点、阳性率、与肿瘤大小和术前视觉功能障碍的关系.结果 OTE征在垂体腺瘤、颅咽管瘤、鞍区脑膜瘤、囊肿性病变、垂体脓肿的阳性分别为6、20、1、0和3例.在垂体瘤,OTE征与肿瘤大小有关,而与术前视觉功能障碍无关.在颅咽管瘤,OTE征与肿瘤大小和术前视觉功能障碍均无关,与肿瘤的生长方式有关,鞍上生长的肿瘤发生OTE征的比例显著高于鞍内鞍上生长的肿瘤(P=0.003).70.8%的OTE征在术后1个月内即可消失.结论 OTE征不是颅咽管瘤的特征件表现,在手术满意切除鞍区良性占位病变后,视束水肿样变多可很快消失.     

鞍区囊性病变的鉴别诊断对手术入路的参考意义

目的 分析和比较颅咽管瘤、囊性垂体腺瘤、Rathke囊肿及垂体脓肿等四种鞍区囊性病变的临床特征,建立鞍区囊性病变的诊断流程.方法 运用统计学方法分析93例鞍区囊性病变患者的临床资料,比较不同患者临床特征的差异.结果 发病年龄较小、病变体积较大、第三脑室压迫、实性部分网状强化常见于颅咽管瘤;海绵窦侵犯、实性部分均匀强化常见于囊性腺瘤;Rathkc囊肿和垂体脓肿多表现为单纯囊性;病程短、尿崩、≥2个腺垂体激素低下及病变环形强化多见于垂体脓肿.结论 鞍区囊性病变的临床特征互相重叠,但又有一定的特异性;综合分析,有助于这四种囊性病变的鉴别.     

扩大经蝶窦显微手术

随着常规经蝶窦显微手术经验的积累、颅底中线区解剖结构研究的深入和神经导航、术中MRI、术中超声、内镜等现代科技的发展,扩大经蝶窦显微手术不仅用于治疗侵袭海绵窦及向鞍上扩展的垂体腺瘤,也逐渐用于治疗非垂体瘤性颅底中线区的病变,即鞍结节脑膜瘤、鞍膈脑膜瘤、颅咽管瘤、表皮样囊肿、斜坡骨肿瘤等.     

Rathke囊肿的诊断与治疗

Rathke囊肿是起源于垂体Rathke囊袋残余组织的良性上皮性囊肿,其发病率占鞍区疾病的7%～8%,临床上容易误诊为垂体腺瘤或者颅咽管瘤。我科于2008年1月至2009年7月共收治了经手术病理证实的Rathke囊肿患者7例,现总结报告如下。     

鞍区囊肿短期迅速缩小1例

鞍区囊性病变主要包括囊性垂体瘤、颅咽管瘤、Rathke囊肿和蛛网膜囊肿，MRI对其诊断和鉴别诊断具有十分重要作用。最近，我院收治1例高度怀疑Rathke囊肿患者，间隔1d再次行MRI检查发现病变缩小，现报道如下。     

鞍区肿瘤术后并发症的处理及护理

鞍区肿瘤包括各型垂体腺瘤，颅咽管瘤及脑膜瘤等。由于解剖关系及其重要结构的存在，手术难度较大，肿瘤本身及手术过程中可对丘脑下部一垂体系统造成一定的损害，产生严重的并发症，如体温异常，尿崩症，水电解质紊乱，癫痛，应激性溃疡，意识障碍等，因此，手术并发症的预防及护理对患者的康复具有重要意义。1临床资料我院自1993年4月～1997年12月共收治鞍区肿瘤患者36例，男对例，女15例，年龄14～1岁，其中垂体瘤20例，颅咽管瘤12例，鞍结节脑膜瘤1例，恶性生殖细胞瘤1例，海绵状血管瘤1例，脊索瘤1例。均经开颅肿瘤切除或部分切除术。…     

鞍区常见占位性病变的临床表现及MRI分析

目的分析鞍区常见占位性病变(垂体瘤、颅咽管瘤、鞍结节脑膜瘤、Rathkes囊肿)的临床表现及MRI表现,以提高术前诊断准确性。方法选取2013-02—2014-06经我院手术治疗病理证实的上述病变,总结、分析其临床表现及磁共振表现。结果鞍区占位病变中,以垂体瘤最为常见,颅咽管瘤次之;临床表现可分为压迫刺激性症状、内分泌症状;实性病变在T1WI、T2WI上可成等、高信号,增强扫描后有强化;而囊性病变信号多变,与所含囊液性质有关。结论鞍区病变是颅内常见的病变,根据患者的临床变现及MRI表现,可提高诊断的准确性。     

经额底纵裂入路显微手术切除鞍区肿瘤

目的 探讨经额底纵裂入路显微外科手术治疗鞍区肿瘤的于术方法及手术技巧.方法 应用经额底纵裂入路显微外科手术切除垂体瘤12例,脑膜瘤5例,颅咽管瘤3例,表皮样囊肿1例.结果 垂体瘤伞切除9例,近全切除3例;脑膜瘤SimpsonⅡ级切除5例;颅咽管瘤全切除3例;鞍上表皮样囊肿伞切除1例.结论 经额底纵裂入路对前颅底、鞍区草要解剖结构有良好暴露,有利于术中对大脑前动脉、颈内动脉、前交通动脉,垂体柄、视交叉、下丘脑及重要穿通血管等结构的保护,手术全切率高,术后出现偏瘫、失语、昏迷、尿崩的发生率低.     

颅咽管瘤根治性手术的经验

不少作者认为,随着颅咽管瘤全摘除机会的增加,而手术死亡率亦同时有所增高,为35%-41.6%.本文经验证明,显微外科技术的临床应用则大大提高了颅咽管瘤的手术根治率和手术效果.作者对83例年龄为4-65岁的颅咽管瘤患者进行了根治性手术.其中47例采用了显微外科技术.根据肿瘤的解剖部位不同可分为三组:鞍内36例,鞍上脑室外29例,鞍上脑室内18例.肿瘤和囊壁全摘除49例,肿瘤全摘除而残留少量囊壁34例.术后26例死亡.鞍内颅咽管瘤根治性手术效果良好.作者认为,当鞍内颅咽管瘤周围有结缔组织增生并与灰结节、漏斗、Willis环、视交叉有粘连而又难以进行区分时,则应放弃全部摘除囊壁的企图.垂体常因鞍内肿瘤     

显微手术治疗鞍区占位性病变23例

目的 探讨鞍区占位性病变的手术治疗方法及疗效。方法 回顾性分析2017年10月至2019年10月手术治疗的23例鞍区占位性病变的临床资料。结果 采用额底外侧入路12例,额底纵裂入路7例,眉弓入路4例。病灶全切除19例（82.6%）,次全切除4例。术后病理结果示垂体腺瘤7例、鞍结节脑膜瘤5例、颅咽管瘤6例、嗅沟脑膜瘤1例、嗅神经鞘瘤1例、Rathke囊肿3例。21例术后恢复良好。术后出现发热10例、电解质紊乱15例、尿崩8例,无死亡病例。23例术后3个月至1年;肿瘤复发4例,其中2例垂体腺瘤、1例颅咽管瘤,再次手术效果良好。结论 对于鞍区占位性病变,良好的手术入路及解剖暴露可提高手术全切除率,减少术后并发症。     

经额底纵裂终板入路切除鞍后、鞍上区及第三脑室前部肿瘤

目的总结经额底纵裂终板入路切除鞍后、鞍上区及第三脑室前部肿瘤的治疗经验。方法回顾性分析32例鞍后、鞍上区及第三脑室前部肿瘤病人的临床资料,其中颅咽管瘤28例,生殖细胞瘤1例,垂体瘤3例。均经额底纵裂终板入路切除肿瘤。结果肿瘤全切除21例,次全切除6例,大部分切除5例;双侧嗅神经均保留29例,垂体柄保留24例。随访30例,时间2个月～2年,仅2例肿瘤大部分切除病人复发再次手术。结论经额底纵裂终板入路适合于切除向鞍后、鞍上区及第三脑室前部生长的肿瘤,术野显露充分,便于保留下丘脑、垂体柄等重要结构,肿瘤全切率高,并发症少,疗效好。     

Chemical meningitis: A rare presentation of Rathke’s cleft cyst

Rathke’s cleft cysts (RCC) are usually benign, sellar and/or suprasellar lesions originating from the remnants of Rathke’s pouch. Rarely, RCC can present with chemical meningitis, sellar abscess, lymphocytic hypophysitis, or intracystic hemorrhage. We describe an unusual presentation of RCC in which the patient presented with a clinical picture of chemical meningitis consisting of meningeal irritation, inflammatory cerebrospinal fluid profile, and enhancing pituitary and hypothalamic lesions, in addition to involvement of the optic tracts and optic nerve.     

Diagnostic and clinical implications of pituicytoma

Pituicytoma is a rare, indolent, benign tumor of the sellar and suprasellar region arising from pituicytes of the neurohypophysis. It is most often diagnosed pre-operatively as a pituitary adenoma. We report two patients with pituicytoma operated on at our Institute over 8 years. Imaging of one patient showed a parasellar and medial temporal extension, which has not been reported to our knowledge. The radiological features that help distinguish this low-grade tumor from other sellar and parasellar tumors are discussed along with its distinct histological findings. The authors also review the literature on its clinical presentation, diagnosis, surgical management and outcome.     

Imaging of sellar and parasellar lesions

The sellar and parasellar region is an anatomically complex area where a number of neoplastic, infectious, inflammatory, developmental and vascular pathologies can occur. Differentiation among various etiologies may not always be easy, since many of these lesions may mimic the clinical, endocrinologic and radiologic presentations of pituitary adenomas. The diagnosis of sellar lesions involves a multidisciplinary effort, and detailed endocrinologic, ophthalmologic and neurologic testing are essential. CT and, mainly, MRI are the imaging modalities to study and characterise normal anatomy and the majority of pathologic processes in this region. We here provide an overview of the most relevant MRI and CT characteristics together with clinical findings of pituitary tumors, vascular, inflammatory and infectious lesions found in the sellar/parasellar region in order to propose an appropriate differential diagnosis.     

A giant retroclival Rathke’s cleft cyst

Rathke’s cleft cyst (RCC) is a rare sellar tumor that can extend to the retroclival region, resulting in brain stem compression. We report a male with short stature who experienced repeated syncope due to compression of the brain stem by a giant retroclival RCC. MRI revealed a large homogeneous sellar tumor with anterior displacement of the pituitary gland that extended to the left retroclival space. The tumor differed from ordinary RCCs because of its unusual clinical presentation, the direction of extension, and its imaging characteristics. The retromastoid surgical approach was used for cyst marsupialization. Intraoperative appearance and histological examination confirmed the diagnosis. A follow-up MRI, 2 years after resection of the cyst, showed no recurrence.     

经翼点入路鞍上脑膜瘤的手术并发症及预防

目的 探讨经翼点入路显微手术切除鞍上脑膜瘤的常见并发症及相关因素，总结其预防方法。方法 回顾性分析160例鞍上脑膜瘤的临床资料。结果 160例鞍上脑膜瘤全切141例(88．1％)，次全切19例(11．9％)，视神经功能改善125例(78．1％)，垂体柄保留155例(96．8％)；主要并发症包括视力恶化(7．5％)，尿崩(16．9％)，电解质紊乱(8．8％)，偏瘫(3．8％)等。手术死亡1例(0．6％)，复发3例(2．5％)。结论 熟悉鞍区的显微解剖和熟练掌握显微外科技术是减少手术并发症的关键，术中须沿肿瘤周围的蛛网膜界面分离和切除肿瘤，仔细辨认并保护好向视器、垂体柄、下丘脑供血的穿支动脉。     

Paraganglioma in pituitary fossa

Paragangliomas are neuroendocrine tumors of paraganglionic tissue which are extremely rare in the sellar area. We present a case of sellar paraganglioma with parasellar and suprasellar extension in a 70‐year‐old man who presented with headache. CT demonstrated sellar mass with suprasellar and right parasellar extension. The lesion was removed subtotally via a trans‐sphenoidal approach. Histopathological diagnosis was paraganglioma. Differential diagnosis between paragangliomas and unusual types of pituitary adenomas, especially null‐cell adenomas, is made by presence of cell nests (Zellballen) in paraganglioma, lack of immunopositivity for pituitary hormones, cytoplasmic immunopositivity for chromogranin A and neuron‐specific enolase, and immunonegativity for cytokeratin 19, cytokeratin 20 and endomysial antibody. In the case of a mass in the sellar region, paraganglioma, although rare, should be included in the differential diagnosis.     

肢端肥大症型垂体腺瘤MRI特点及其与血清GH水平、肿瘤GH表达水平的关系分析

目的探讨肢端肥大症型垂体腺瘤MRI特点及其与血清生长激素（GH）水平、肿瘤GH表达水平之间的关系。方法回顾性分析2008年1月~2013年6月采用经鼻蝶入路显微手术切除的84例肢端肥大症型垂体腺瘤患者的临床资料。结果 MRI显示肿瘤可突破鞍膈向鞍上生长、突破鞍底向蝶窦内生长,鞍下侵犯指数[（2.35±0.69）cm]明显高于鞍上侵犯指数[（0.66±0.25）cm;P〈0.01]。术前血清GH水平与瘤体大小、肿瘤GH表达水平之间无明显相关性（P〉0.05）。结论肢端肥大症型垂体腺瘤有明显的向蝶窦内优先侵犯生长的趋势;其术前血清GH水平、肿瘤GH表达水平及瘤体大小之间无明显相关性。     

A rare case of pituitary adenoma with calcification: a case report

Though craniopharyngioma remains the most common sellar suprasellar tumor with calcification, it can be seen very rarely in pituitary adenomas and Rathke's cleft cysts. Appreciation of the pattern of calcification in a sellar suprasellar lesion can give a clue to the nature of the lesion. The authors describe a 53-yearold male with a cystic sellar suprasellar lesion and curvilinear calcification that was managed by successful transsphenoidal surgery. The present case highlights the occurrence of calcification in a pituitary adenoma and the importance of recognizing the calcification pattern for pre-operative diagnosis of sellar suprasellar lesions that can help plan the surgical strategy and management.     

经纵裂蝶窦入路显微外科切除巨大侵袭性垂体腺瘤

目的 研究巨大侵袭性垂体腺瘤的手术入路,探讨肿瘤全切除的方法,以及术后并发症的防治。方法 采用改良冠状开颅,经大脑纵裂、蝶窦入路。结果：施术３０例,肿瘤显微镜下全切除２２例,全切除率达７３％。２７例随访２～３年,２３例恢复正常工作,肿瘤无复发。结论：该手术入路充分显露蝶鞍、蝶窦、鞍旁及鞍后,是切除巨大侵袭性垂体腺瘤的较理想方法。