垂体瘤凝固性坏死七例报告并文献复习  

Pituitary adenoma coagulation necrosis： seven cases report and literatures review

作　　者：任铭[1] 张宏伟[1] 张明山[1] 曲彦明[1] 夏雷[1] 王浩然[1] 朱明旺 于春江[1] 

机构地区：[1]北京三博脑科医院首都医科大学第十一临床医学院神经外科,100093 [2]放射科

出　　处：《中华神经外科杂志》2014年第2期144-146,共3页Chinese Journal of Neurosurgery

基　　金：国家临床重点专科建设项目基金（SG2011-03-3）

摘　　要：目的探讨垂体瘤凝固性坏死的临床表现、影像学特点、治疗及预后。方法总结7例垂体瘤凝固性坏死的临床病例资料，并文献复习。结果急性起病2例，亚急性起病5例。头痛6例、恶心呕吐3例、视力下降7例、视野缺损6例、眼肌麻痹3例、发热1例。全垂体功能低下4例；仅性腺轴功能低下1例；正常2例。MRI平扫以短T1为主的混杂信号6例，呈短他低信号环5例；增强扫描肿瘤周边强化7例。术中见肿瘤呈黄白色豆渣样物质6例，呈沙砾样固体组织1例。术后2个月死亡1例，其余6例长期随访预后良好。结论垂体瘤凝固性坏死是一种特殊类型的梗死性卒中，有特征性MRI表现；经蝶手术治疗为其首选治疗方式，效果理想。Objective To summary the clinical manifestations, imaging findings, the treatment and prognosis of pituitary adenoma eoagulative necrosis. Methods Seven cases were analyzed and the literatures were reviewed. Results In these seven patients, headache （ 6/7 ） , nausea and vomiting （ 3/7 ） , visual disturbance （ 7/7 ）, visual field defect （ 6/7 ）, ophthalmoplegia （ 3/7 ） and fever （ 1/7 ） were presented. Endocrine test showed hypopituitarism in four cases and hypogonadotropin in one. Magnetic resonance image （MRI） showed six had mixed intensity signal with hyperintense signal in the majority on Tl-weighted image; five had peripheral ring hypointense signal on T2-weighted image. With gadolinium （Gd） enhancement, all seven masses showed peripheral rim enhancement, All the seven patients were finally diagnosed as pituitary adenoma coagulative necrosis pathologically after surgery via transsphenoidal approach. The mass showed yellowy white soybean dregs similar materials in six cases, and pale yellow solid substance in one case. One patient was died two months after surgery; the others showed no recurrence and hypopituitarism as follow-up. Conclusions Pituitary adenoma coagulative necrosis is one rare type of infarction pituitary apoplexy, with unique of MRI scan. Transsphenoidal surgery is indicated for patients with severe svmotoms and the nroznosis is zood.

关 键 词：垂体瘤 卒中 坏死 

分 类 号：R736.4[医药卫生—肿瘤]