鞍区Rathke囊肿的诊断及显微手术治疗

目的 探讨鞍区Rathke囊肿的术前诊断和手术治疗。方法 对2000年3月至2007年6月我院收治的21例经手术及术后病理检查证实的Rathke囊肿病人的临床资料进行回顾性分析。此21例中。8例男性，13例女性；入院后21例病人均行了头颅CT和MRI检查。鞍区Ratllke囊肿患者临床表现包括头痛、视野缺损及内分泌功能紊乱等。15例经鼻-蝶窦入路，6例经右侧额下入路显微手术切除病变。结果 术前正确诊断为Rathke囊肿11例。其余10例均被误诊。术后随访3个月至5年，患者头痛症状和视力、视野障碍均有改善，术前有内分泌功能障碍者术后63．6％（7／11）得到改善，无复发病例。结论 鞍区Rathke囊肿术前较难明确诊断。MRI检查有助于其鉴别诊断。经蝶窦显微手术是有效的治疗方法。     

鞍区Rathke囊肿的诊断和显微外科治疗

目的 分析和探讨鞍区。Rathke囊肿的诊断和治疗。方法 27例经手术和病理证实为鞍区Rathke囊肿，其中男10例，女17例。平均年龄31岁。平均病程28．7个月。采用经鼻蝶入路显微手术清除囊内容物，囊壁部分切除，开放囊腔。结果随访半年至3年，头痛及视功能障碍的病例的症状全部得到缓解，11例内分泌症状者中8例恢复正常。结论 鞍区Rathke囊肿术前易与垂体腺瘤、囊性颅咽管瘤混淆，较难作出正确诊断。高分辨率MRI检查有助于鉴别。经鼻蝶窦显微外科手术是治疗本病的有效方法。     

Rathke囊肿的临床诊断及外科治疗分析(附7例报告)

目的分析和讨论Rathke囊肿的诊断和显微外科手术治疗方法及效果。方法对2000年5月至2009年6月间经手术和病理证实的7例Rathke囊肿病例,均采用经鼻—蝶窦入路并术中辅助内镜手术治疗。结果 7例Rathke囊肿手术治疗过程均顺利,无并发症发生,无死亡病例,术后患者临床症状均明显好转。术后1～2个月患者激素水平均恢复正常。随访6月至5年无复发。结论 Rathke囊肿术前较难明确诊断,CT与MRI检查有一定特异性,但难以与其它鞍区囊性病变相鉴别。经蝶窦入路显微手术是目前Rathke囊肿的最安全有效的治疗方法。     

鞍区Rathke囊肿的诊断及手术治疗(附13例分析)

目的探讨鞍区Rathke囊肿的诊断和治疗方法。方法对13例Rathke囊肿病例采用单鼻孔蝶窦入路或翼点入路显微外科手术治疗，切除部分囊壁，敞开囊腔，清除囊肿内容物。结果术后随诊6个月～3年，本组症状均有缓解，1例术后1年复发。结论鞍区Radthke囊肿CT、MRI检查无特异性，术前较难明确诊断。经单鼻孔蝶窦入路显微外科手术是其有效治疗方法，可以明确诊断，缓解症状。     

神经内镜下经鼻蝶入路手术治疗鞍区Rathke囊肿（附23例报道）

目的 探讨神经内镜下经鼻蝶入路手术治疗鞍区Rathke囊肿的疗效。方法 回顾性分析2008年1月 至2013年8月神经内镜下经鼻蝶入路手术治疗的23例鞍区症状性Rathke囊肿的临床资料。结果 术后临床症状均有不同程度改善或消失。术中发生2例脑脊液漏。23例术后均未行辅助放疗,随访3个月到2年,复查CT或MRI仅有1例复发。结论 神经内镜下经鼻蝶入路手术是治疗鞍区症状性Rathke囊肿的有效方法之一,可以缓解临床症状。     

神经内镜下经单鼻孔蝶窦人路切除鞍区病变40例临床分析

目的 总结神经内镜下经单鼻孔蝶窦入路手术治疗鞍区病变的方法和经验.方法 北京市海淀医院神经外科自2006年6月至2009年10月采用神经内镜下经单鼻孔蝶窦入路手术治疗鞍区病变患者40例,其中垂体腺瘤38例,Rathke囊肿2例.回顾性分析患者的临床资料和治疗效果.结果垂体瘤38例中全切除35 例(92.1%),大部切除3例(7.9%),2例Rathke囊肿均全切除.随访结果显示垂体瘤患者中33例(86.8%)治愈,5例(13.2%)控制,全部患者术后未有严重的永久性并发症.结论 经单鼻孔蝶窦入路手术治疗鞍区病变创伤小、安全、方便.     

Rathke囊肿并垂体腺瘤2例报告并文献复习

目的总结垂体腺瘤伴Rathke囊肿的临床特征与治疗方法。方法回顾性分析2例经手术病理证实伴有Rathke囊肿的垂体腺瘤病例资料。结合临床特征、影像学表现、手术治疗以及相关文献进行分析。结果 2例病人均经翼点入路行开颅手术,术后病理结果为垂体腺瘤合并Rathke囊肿。1例术后随访13个月复查MRI示未见肿瘤及囊肿复发,1例术后视力较术前好转。结论伴有Rathke囊肿的垂体腺瘤临床罕见,鞍区MRI提示垂体腺瘤旁存在囊性信号应考虑合并Rathke囊肿。临床明确诊断依赖于组织病理学观察及免疫组化标记。对于压迫症状明显且伴有Rathke囊肿的垂体腺瘤可手术治疗。     

垂体Rathke囊肿的诊断和显微手术治疗

目的 分析和讨论垂体Rathke囊肿的诊断和手术治疗。方法 回顾分析41例经手术和病理证实的垂体Rathke囊肿的病例，男性16例，女性25例，平均年龄32.8岁，平均病程为20.6个月。主要临床表现包括头痛（62.5%)。垂体功能紊乱（55%），视功能障碍（32%）等。CT及MRI检查发现鞍区囊性肿物。39例采用经口鼻蝶窦入路显微外科手术，2例采用开颅手术，切除部分囊壁，敞开囊腔，清除囊肿内容物，结果 术前正确诊断为垂体Rathke囊肿的仅为7例。术后随诊3月至8年，头痛患的症状全部缓解，垂体功能紊乱患55%得到改善，视功能障碍患75%得到改善，41例患术后均无复发。结论 垂体Rathke囊肿术前较难明确诊断，MRI检查信号呈多样性，无特异性，经口鼻蝶窦入路显微外科手术可以明确诊断，缓解症状，患预后良好，是治疗垂体Rathke囊肿的有效方法。     

有症状的Rathke囊肿(附14例报告)

目的探讨有症状的Rathke(拉克氏)囊肿的诊断和手术治疗。方法回顾性分析14例有症状的Rathke囊肿的临床表现,MR影像特点,内分泌改变,术后症状缓解情况。其中12例经颅手术,2例经鼻蝶手术。结果术前正确诊断为Rathke囊肿4例,术后视力、视野得到改善8例,术后内分泌改善6例,术后出现一过性尿崩3例。14例随访3～48个月无复发。结论了解Rathke囊肿的影像学特点,对提高术前的正确诊断率大有裨益,对于鞍内鞍上型Rathke囊肿开颅手术是一种可取的方法。     

拉克囊肿临床探讨简

拉克囊肿（Rathke）是一种发生于鞍区Rathke囊袋残余组织的先天性非肿瘤性病变,多见于鞍内或鞍上。根据一宗大型尸体研究报告显示,在颅内鞍区小病变中,最常见的是拉克囊肿,约占22％。尽管其有较高的流行程度,但鞍区病变经鼻蝶手术切除的患者中,只有2％-9％的患者被诊断为拉克囊肿。大多数拉克囊肿无临床症状,     

症状型Rathke裂隙囊肿的临床特征及外科治疗（附13例报告）

目的 探讨症状型Rathke裂隙囊肿的临床特点及手术治疗效果。方法 回顾性分析自2008年10月至2014年8月经手术治疗的13例症状型鞍区Rathke裂隙囊肿患者的临床资料,内镜下经鼻蝶入路11例,开颅显微手术2例,术中均清除囊内容物,囊内容物送细菌学培养,镜下完全（9例）或部分切除（4例）囊壁。结果 随访6个月~3年,术后头痛缓解率100%,视力障碍缓解率80%,内分泌功能紊乱症状得到不同程度的缓解。细菌培养阳性者4例,术后复发2例。结论 症状型Rathke裂隙囊肿临床表现无特异性,影像学表现多样,部分患者术前明确诊断较困难。手术应在充分减压的同时尽可能地切除囊壁,术中应对较为粘稠的囊内容物进行细菌培养,减少颅内感染及囊肿复发。     

Clinical features of symptomatic Rathke's cleft cyst

To investigate the clinical features of Rathke's cleft cysts (RCCs), we retrospectively analyzed 15 cases with histologically confirmed RCCs. All patients underwent formal testing of visual field, endocrinological evaluation and magnetic resonance imagings. As overall presenting symptoms, endocrine disturbance was the most common symptoms, followed by visual disturbance and headache. Among the endocrine disturbances based on adenohypophysial dysfunction, hyperprolactinemia was most common. Considering the size of RCCs, RCCs could induce hyperprolactinemia only when the cysts became large enough to compress the infundibular system. Our series showed relative high incidence of pituitary dwarfism and diabetes insipidus (DI). These facts indicated that RCCs could evoke hyposecretion of growth hormone in young patients and DI in aged patients by direct compression of the pituitary gland in the early stage of progression. All cases who had headache had no other symptoms. We could not prove the evidence that RCCs could induce headaches in these cases. This might be suggested that headache could not be a sole symptom in cases of RCCs.     

有症状的Rathke's裂隙囊肿的临床特点及手术治疗

目的 探讨有症状的Rathke's裂隙囊肿术前术后内分泌功能紊乱情况及处理方法,以及术后复发问题.方法 对11例经病理证实的Rathke's裂隙囊肿患者的临床表现、影像学特点、内分泌改变及手术治疗方法进行叫顾性分析.结果 4例术前头痛患者术后均缓解,6例术前视力障碍术后缓解5例,9例术前性功能障碍及月经紊乱术后好转6例,而乖体功能低下及尿崩症不易恢复.在12～66月(平均34.5月)随访中,经颅全切除6例末见复发,而经蝶手术5例中 2例大部切除者复发,复发2例病理上均合并慢性炎症浸润及局灶性鳞状上皮细胞.结论 Rathke's裂隙囊肿临床及影像学表现各异,术前确诊常常存在困难.术前术后患者的内分泌功能障碍需要进行全面的评价及激素替代治疗.术中尽量追求囊肿的全切除并取得足够的病理组织对明确诊断、判断预后有重要的意义,对于合并有鳞状细胞及炎性细胞浸润的患者术后应注意密切随访.     

颅咽管瘤经蝶显微手术治疗

目的:经蝶显微手术切除颅咽管瘤,适用起源于鞍底的肿物或向鞍上扩展者。作者回顾性总结了18例颅咽管瘤的诊断方式、手术技巧和治疗结果。方法:本组均经计算机体层摄影(CT)或磁共振成像(MRI)扫描确诊。手术采取经唇下—鼻中隔—蝶窦入路或经鼻前庭-鼻中隔—蝶窦入路两种方式行肿瘤切除术。结果:9例肿瘤获全切除,4例次全切除,其余5例为部分切除,无术后死亡。15例获长期随访(平均随访期为3年1个月),有12例(80％)恢复良好,3例影像学检查提示肿瘤复发,需行再次手术、放疗或放射外科治疗。结论:对颅咽管瘤选择合适病例经蝶入路显微手术切除,是一种安全、有效的方法。     

Analysis of Empty Sella Secondary to the Brain Tumors

Objective

The definition of empty sella syndrome is ''an anatomical entity in which the pituitary fossa is partially or completely filled with cerebrospinal fluid, while the pituitary gland is compressed against the posterior rim of the fossa''. Reports of this entities relating to the brain tumors not situated in the pituitary fossa, have rarely been reported.

Methods

In order to analyze the incidence and relationship of empty sella in patients having brain tumors, the authors reviewed preoperative magnetic resonance imaging (MRI) of 72 patients with brain tumor regardless of pathology except the pituitary tumors. The patients were operated in single institute by one surgeon. There were 25 males and 47 females and mean patient age was 53 years old (range from 5 years to 84 years). Tumor volume was ranged from 2 cc to 238 cc.

Results

The overall incidence of empty sella was positive in 57/72 cases (79.2%). Sorted by the pathology, empty sella was highest in meningioma (88.9%, p = 0.042). The empty sella was correlated with patient''s increasing age (p = 0.003) and increasing tumor volume (p = 0.016).

Conclusion

Careful review of brain MRI with periodic follow up is necessary for the detection of secondary empty sella in patients with brain tumors. In patients with confirmed empty sella, follow up is mandatory for the management of hypopituitarism, cerebrospinal fluid (CSF) rhinorrhea, visual disturbance and increased intracranial pressure.     

Visual field defects in hydrocephalus

Eight patients representing visual field defects associated with hydrocephalus are reviewed. Seven cases had aqueductal stenosis and one had congenital communicating hydrocephalus. We found five cases of defects in visual field typical of a chiasmal or optic nerve lesion: (1) inferior altitudinal hemianopia with inferior nasal quadrantanopia in the opposite eye; (2) inferior binasal quadrantanopia; (3) unilateral inferior nasal depression; (4) unilateral temporal defect; (5) bilateral central scotoma. In these cases CT demonstrated moderate or marked symmetrical dilatation of the third and lateral ventricles. Four out of five cases showed bulging of the third ventricle anteriorly into the sella turcica on CT or ventriculography. Other three patients had incongruous homonymous hemianopia. Characteristic asymmetrical dilatation of the lateral ventricles was noted in all three cases. The more enlarged lateral ventricles were ipsilateral with the affected visual pathways. The sites of lesion responsible for these field defects seemed to be optic tract in one case and optic radiation in two cases. Ventriculoperitoneal shunt was placed in five out of seven cases. Impaired visual field improved in three patients after shunt insertion. A 28-year-old female who had history of blurred vision fos 14 days showed improvement in visual acuity and field when the enlarged ventricles became slit-like by shunting. In the other two patients defects in visual fields improved in spite of consistent ventriculomegaly. These facts suggested that not only the mechanical forces with distended third ventricle but also increased intracranial pressure played an important role in producing visual field defects in hydrocephalic patients.     

Asymptomatic enlargement of the sella turcica.

Forty-six patients with enlarged sella turcica and pneumographic evidence of an intrasellar mass were initially untreated. The courses were variable, and 50% did not require subsequent treatment. All patients with initial visual involvement developed progressive visual impairment. Of patients with clinical evidence of pituitary insufficiency, 66% developed visual field defects and required treatment. Only one patient, whose sole symptom was headache, was subsequently treated, and no asymptomatic patient developed subsequent symptoms and required treatment. Asymptomatic patients with an enlarged sella turcica should have an air study to exclude an "empty sella" syndrome or primary hypothyroidism.     

垂体Rathke囊肿的诊断和手术治疗

目的分析和讨论垂体Rathke囊肿的诊断和手术治疗。方法回顾分析41例经手术和病理证实的垂体Rathke囊肿的病例,男性16例,女性25例,平均年龄32.8岁,平均病程为20.6月。主要临床表现包括头痛(62.5%)、垂体功能紊乱(55%)、视功能障碍(32%)等。CT及MR检查发现鞍区囊性肿物。39例采用经口鼻蝶窦入路显微外科手术,2例采用开颅手术,切除部分囊壁,敞开囊腔,清除囊肿内容物。结果术前正确诊断为垂体Rathke囊肿的仅为7例,术后随诊3月至8年,头痛病人的症状全部缓解,垂体功能紊乱病人55%得到改善,视功能障碍病人75%得到改善。41例病人术后均无复发。结论垂体Rathke囊肿术前较难明确诊断,MR检查信号呈多样性,无特异性。经口鼻蝶窦入路显微外科手术可以明确诊断,缓解症状,患者预后良好,是治疗垂体Rathke囊肿的有效方法。     

Does pseudotumor cerebri cause the empty sella syndrome?

Eight patients had both the "primary empty sella syndrome," diagnosed by the finding of an air-filled sella turcica at pneumoencephalography, and pseudotumor cerebri, diagnosed by the finding of an elevated cerebrospinal fluid pressure in the presence of normal ventricular size and position on pneumonencephalography. All eight patients were obese women, and six were hypertensive. Six complained of headaches and menstrual irregularities, and two were asymptomatic. Three had visual symptoms and four had papilledema at the time of examination. These two clinical disorders appear to be frequently related, and when they are related, visual field defects and visual loss are more likely to occur than when either entity appears alone. Chronically increased intracranial pressure from pseudotumor cerebri may produce an empty sella if the diaphragma sella is incompetent and the subarachnoid space herniates into the sella turcica.     

Surgically treatable growth retardation due to non-neoplastic pituitary-hypothalamic dysfunction

Out of 90 children, examined because of growth failure, 15 have been treated surgically. The diagnoses were intrasellar arachnoid diverticulum or empty sella (5 cases), enlarged chiasmatic cisterns (5 cases), chronic 'occult' hydrocephalus (5 cases). Surgery was followed by an immediate increase in growth rate in almost all the cases, even if the result was persistent only in some subjects. In percentage, better results were obtained in patients with enlarged chiasmatic cisterns and chronic occult hydrocephalus than in patients with arachnoid diverticulum or empty sella. The evaluation of prolactin serum levels was demonstrated to be useful both in preoperative diagnosis and postoperative control.