19例Rathke囊肿的诊断和显微手术治疗

目的提高Rathke囊肿的术前诊断率和探讨最佳手术方法。方法回顾分析19例经术后病理证实为Rathke囊肿的病例。主要临床表现包括头痛(63.2%),视觉缺陷(53.6%)及下丘脑-垂体功能紊乱(42.1%)。术前CT及MRI检查发现均为鞍区囊性肿物。13例采用经鼻-蝶窦入路显微外科手术,6例采用经右额底开颅手术。结果术前正确诊断垂体Rathke囊肿的9例,术后随访3个月,病人的头痛症状全部缓解,下丘脑-垂体功能紊乱62.5%得到改善,视觉缺陷80%得到改善。19例病人术后10个月均无复发。结论Rathke囊肿术前CT与MRI检查均有一定特异性,结合CT与MRI检查能提高Rathke囊肿术前诊断率。经鼻-蝶窦入路显微手术治疗是目前治疗Rathke囊肿的最佳方法。

Diagnosis and microsurgical treatment of 19 cases of Rathke cleft cyst

Objective To analyze the diagnosis and microsurgical treatment of Rathke cleft cyst.Methods The clinical data of 19 pathologically-diagnosed Rathke cleft cyst patients treated by microsurgery were retrospectively reviewed and analyzed.Results The typical clinical manifestations of the disease were headache((63.2%)),visual deficiency((53.6%)),and pituitary dysfunction((42.1%)).Computed tomography(CT) and magnetic resonance imaging(MRI) showed cystic mass in the area of sella tureica.Only 9 cases were correctly diagnosed before operation.Thirteen cases were treated by trans-sphenoidal microsurgery,while 6 cases through craniotomy.In 3 months to 5 years of follow-up,no case relapsed;and headache disappeared in all cases,(62.5%) patients with pituitary dysfunction improved, and 80% with visual deficiency recovered.Conclusion CT and MRI may improve the pre-surgery diagnosis of Rathke cleft cyst.Trans-sphenoidal microsurgery is an effective procedure for treatment of the disease.