延迟性脑脊液鼻漏病理机制及诊治探讨

目的总结15例经手术治疗的延迟性脑脊液鼻漏的临床资料,探讨脑脊液鼻漏的病理机制及其与诊断治疗的关系。方法本组共15例脑脊液鼻漏患者,其中颅底骨折13例,自发性1例和垂体瘤术后1例。重点分析术前CTMRI扫描,术中所见,以及疗效三者之间的关系。结果术中见14例患者神经组织疝入鼻窦,垂体瘤术后鼻漏为鞍上池下疝,其中后7例的CT扫描显示骨缺损,MRI显示神经组织下疝与术中所见完全一致。15例术后14例治愈,1例无效,无手术并发症。结论神经组织或鞍上池经颅底缺损疝入鼻窦为外伤后或自发性脑脊液鼻漏不能自愈的病理机制的重要环节,由于上述组织的疝入,导致粘膜、硬膜、蛛网膜难以修复。冠状CT扫描和MRI可确定瘘口部位,如果冠状CT有骨缺损,MRI检查相应部位有脑组织下疝,应积极早期手术治疗。     

Empty Sella and Headache

SYNOPSIS
Empty sella is an anatomical condition caused by herniation of the subarachnoid space into the pituitary fossa through an incompetent seller diaphragm. Headache seems to be one of the most frequently reported symptoms. We studied 13 headache patients (12 females, 1 male) presenting with primary empty sella (PES) on CT scan. The characteristics of the headache were analyzed and plasma levels of pituitary hormones or cortisol assessed. We confirmed the nonspecific nature of the headache in PES even though the majority of our patients complained of daily headache, mostly localized anteriorly. Hormone plasma levels were within normal range in all the patients assessed. However, four patients reported earlier endocrine disorders and more than half of the patients presented with obesity.
In our opinion, PES should be suspected in middle-aged overweight women with daily headache even in the absence of endocrine symptomatology.     

鞍区肿瘤术后中枢性低钠血症的诊断和治疗

目的:探讨鞍区肿瘤术后中枢性低钠血症的诊断及处理方法。方法:对我科近四年鞍区肿瘤术后并发中枢性低钠血症的58例患者进行回顾性分析,术前、手术当日及术后每日定时检测血钠,观察尿量变化,测定中心静脉压,确定低钠血症的类型并给予相应的处理。结果:56例恢复正常,1例死于严重肺部感染,1例自动出院。结论:鞍区肿瘤易出现抗利尿激素分泌不当综合症和脑性耗盐综合症两种类型。前者需限水治疗,后者应予以充分补钠、补水,根据水、钠检测水平治疗。     

Idiopathic normal pressure hydrocephalus associated with empty sella

A 70-year-old female presented with the clinical triad of normal pressure hydrocephalus (NPH) and senile tremor. Neuroimaging disclosed findings of both NPH and empty sella (ES). A ventriculoperitoneal shunt did not modify the clinical course except for a mild and transient improvement, and shunt malfunction occured later on. The association of NPH and ES may result from a common underlying mechanism such as transient increases in intracranial pressure.     

蝶鞍区塑化薄片断层解剖学研究

为了给临床蝶鞍区手术提供详细的解剖学资料，用中年男性标本３０例，采用Ｐｌａｓｔｉｎａｔｉｏｎ技术，分别作成蝶区连续横、矢、冠状薄片断层标本，进行解剖学观测，结果显示：董体的左右径大于前后径或上下径，对于垂体病变，宜进行三方位对照观察，以了解垂体的形态变化。展神经与海绵窦外侧壁之间有间隙存在，说明展神经并不走行于外侧壁中，而是位海绵窦内。紧贴视交叉的外侧，颈内动脉由海绵窦段的前升冲突芊     

鞍区颗粒细胞瘤

鞍区颗粒细胞瘤非常罕见,至今报道有症状的颗粒细胞瘤还不足５０例,文章回顾自１８９３发现鞍区颗粒细胞瘤经以来对颗细胞瘤的结构特点、组织起源的研究,以以及临床表现、诊断及鞍区颗粒细胞瘤的治疗     

蝶鞍的X线观测及临床意义

目的 :为临床颅内占位性病变的诊断提供依据。方法 :随机选取成年头颅侧位 X线平片 ,对鞍背厚度 ,鞍结节形态及角度 ,蝶鞍形态、前后径及深径进行观测。结果 :鞍背厚度为 5 .0 9± 1.13mm;鞍结节形态常见型 93.5 % (2 46例 )、锐利型 1.2 %(3例 )、平坦型 1.2 % (3例 )、垂直型 2 .3% (6例 ) ,鞍结节角度 12 5 .6 4°± 11.97°;蝶鞍形态为椭圆形的占 88% (2 2 7例 ) ,圆形的占8.1% (2 1例 ) ,扁平形的占 3.9% (10例 ) ,蝶鞍前后径 11.7± 2 .31mm ,深径 9.5± 1.6 9mm。结论 :所测结果可作为国人正常 X线解剖数据标准     

Wegener's granulomatosis with unusual cavernous sinus and sella turcica extension

Intracerebral extension of Wegener's granulomatosis (WG) is rare. We present a patient with oculomotor and trochlear nerve palsy with histologically proved WG. An MR examination revealed granulomatous tissue in nasal cavity, paranasal sinuses with meningeal infiltration, and uncommon penetration into cavernous sinus and sella turcica. The MR images before and during pharmacological therapy are presented. Received: 14 July 1998; Revision received: 12 October 1998; Accepted: 13 January 1999     

空蝶鞍综合征20例的临床和MRI分析

分析２０例空蝶鞍综合征（ＥＳＳ）的ＭＲＩ表现和其中１６例的内分泌改变。结果１６例ＥＳＳ均有内分泌功能异常。ＭＲＩ表现有蝶鞍充满长Ｔ＿１和长Ｔ＿２的脑脊液;垂体受压至鞍底,冠状位呈“锚”状,矢状位呈“新月”状;垂体柄延长。结果表明ＥＳＳ常具有内分泌功能紊乱,ＭＲＩ对ＥＳＳ具有特征性诊断意义。     

Complete Sella Turcica Bridges Prevalence and Dimensions

Interclinoid ligaments which connect the anterior and posterior clinoid processes comprise a group of intrinsic ligaments of sphenoid bone. The complete sella turcica bridge corresponds to the complete ossification of the interclinoid ligaments. 112 dry human adult skull bones were studied for presence of ossified interclinoid ligaments. Nine skulls (8.04%) showed sella turcica bridges, out of which six were unilateral and three bilateral. The average length of the bridge was 11.67mm. The average width and thickness at the anterior clinoid process was 6.33mm and 4.33mm ; atthe middle of the bridge 3.08mm and 2.66mm; and atthe posterior clinoid process, 4.91 mm and 3.66mm, respectively. Anomalies of sellar region are not very rare and may pose difficulties in interpretation of Magnetic Resonance Imaging or Computed Tomographyforthe radiologist. Thesefindings would also guide the neurosurgeons in planning neurosurgical procedures involving the sellar region.