内镜下经鼻蝶入路单纯肌肉填塞法治疗鞍内蛛网膜囊肿的临床效果

目的探讨经鼻蝶入路单纯肌肉填塞法治疗鞍内蛛网膜囊肿的临床效果。方法回顾性分析2014年1月至2020年2月于郑州大学第一附属医院神经外科行经鼻蝶入路单纯肌肉填塞法治疗的11例鞍内蛛网膜囊肿患者的临床资料。男性5例, 女性6例, 中位年龄48岁(范围:23～75岁)。临床表现包括头痛6例, 头晕4例, 性欲减退1例, 意识障碍1例, 视力障碍7例和混合性垂体功能障碍5例。患者术前MRI图像均可见鞍窝扩大, MRI增强图像显示鞍内蛛网膜囊肿囊壁未见强化, CT图像可见鞍底受压变薄。9例患者囊肿向鞍上扩展, 鞍隔受压呈"弓形", 7例囊肿向上压迫视交叉。患者均于神经内镜下经鼻蝶入路切开囊肿壁, 充分引流并填塞肌肉。观察患者术后症状、垂体内分泌功能改善情况及复发情况。结果所有患者术后鞍区MRI图像可见囊肿明显减小或消失。发生颅内感染1例, 电解质紊乱2例, 给予对症治疗后均缓解。术后未发生脑脊液鼻漏。患者术后临床症状完全缓解6例, 部分缓解5例;垂体内分泌功能完全恢复2例, 明显改善者4例。患者术后均获得随访, 随访时间10～40个月。1例患者术后3个月发现囊肿部分复发, 因未出现新发症状, ...

Clinical effect of endoscopic transnasal sphenoidal approach with simple muscle packing for intrasellar arachnoid cyst

Objective To examine the clinical effect of simple muscle packing through transnasal sphenoid approach in the treatment of intrasellar arachnoid cyst.Methods The clinical data of 11 patients with intrasellar arachnoid cyst treated by transnasal sphenoidal approach with simple muscle packing at the Neurosurgery Department of the First Affiliated Hospital of Zhengzhou University from January 2014 to February 2020 were retrospectively analyzed.There were 5 males and 6 females,with a median age of 48 years(range:23 to 75 years).The clinical manifestations included headache in 6 cases,dizziness in 4 cases,hypo-libido in 1 case,disturbance of consciousness in 1 case,visual impairment in 7 cases and mixed pituitary dysfunction in 5 cases.The enlargement of the sellar fossa was seen in the preoperative MRI images.The enhanced MRI images showed that the cyst wall of the intrasellar arachnoid cyst was not enhanced,and the compression and thinning of the sellar base was seen in the CT images.In 9 cases,the cyst extended suprasellar and the sellar septum was"arched".In 7 cases,the cyst compressed the optic chiasm upward.The cyst walls of all patients were incised through the nasal sphenoid approach under the endoscope,and the muscle was packed after sufficient drainage.The postoperative symptoms,pituitary endocrine function and recurrence of patients were followed up.Results MRI images of the sellar region in all patients showed significant reduction or disappearance of cysts.Intracranial infection occurred in 1 case and electrolyte disorder in 2 cases,which were relieved after symptomatic treatment.No cerebrospinal fluid rhinorrhea occurred.Postoperative clinical symptoms were completely relieved in 6 cases and partially relieved in 5 cases.Pituitary endocrine function recovered completely in 2 cases and improved significantly in 4 cases.All patients were followed up for 10 to 40 months.One patient found to have a partial recurrence of the cyst 3 months after surgery.Because there were no new symptoms appeared,the follow-up was continued without second operation.Conclusion Transnasal sphenoidal approach is a feasible method for the treatment of intrasellar arachnoid cyst.