扩大经鼻-经鞍结节入路神经内镜手术治疗鞍上Rathke's囊肿的疗效分析  

Clinical efficacy of surgery via extended endoscopic endonasal transtuberculum transplanum approach for patients with suprasellar Rathke's cleft cysts

作　　者：李倩 武丹洋 宋东昊 杨绍成 续岭 柯代波 谢明祥 肖顺武 LI Qian;WU Dan-yang;SONG Dong-hao;YANG Shao-cheng;XU Ling;KE Dai-bo;XIE Ming-xiang;XIAO Shun-wu(Department of Neurosurgery,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,China)

机构地区：[1]遵义医科大学附属医院神经外科,贵州遵义563000

出　　处：《中国临床神经外科杂志》2024年第1期4-7,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨鞍上Rathke’s囊肿(RCCs)的临床特点及扩大经鼻-经鞍结节入路神经内镜手术的疗效。方法回顾性分析2018年10月至2021年8月收治的11例鞍上RCCs的临床资料,均行扩大经鼻-鞍结节入路神经内镜手术治疗。结果根据影像学特征及神经内镜下探查分型:鞍上型7例,脚间池型2例,垂体柄型1例,混合型1例。入院血清泌乳素增高5例、头痛10例、视力受损5例、月经紊乱2例,术后均改善。术后随访0.5~30个月,出现迟发性脑脊液鼻漏1例、蝶窦脓肿1例,无囊肿复发。结论鞍上RCCs易出现症状,根据术前头颅MRI和术中神经内镜表现进行分型,有利于术中对囊周结构的保护,并制定有效手术方案。在掌握颅底重建技术基础上,经鼻-鞍结节扩大入路神经内镜手术治疗鞍上RCCs是安全的、有效的,而且创伤较小。Objective To investigate the clinical features of suprasellar Rathke's cleft cysts(RCCs)and the clinical efficacy of surgery via extended endoscopic endonasal transtuberculum transplanum approach(EEETTA)for them.Methods The clinical data of 11 patients with suprasellar RCCs treated with surgery via EEETTA from October 2018 to August 2021 were retrospectively analyzed.Results According to the imaging features and neuroendoscopic findings,the RCCs were divided into four types:suprasellar type(n=7),intercisternal type(n=2),pituitary stalk type(n=1),and mixed type(n=1).Increased serum prolactin occurred in 5 patients,headache in 10,visual impairment in 5,and menstrual disorder in 2 on admission.All symptoms were significantly improved after surgery.During the follow-up(0.5~30 months),delayed cerebrospinal fluid rhinorrhea occurred in 1 patient and sphenoid sinus abscess in 1.There was no recurrence of cysts in all patients.Conclusions Suprasellar RCCs is prone to symptoms,and classification according to preoperative MRI and intraoperative neuroendoscopic findings is helpful to the protection of pericapsular normal tissues and the formulation of surgical plan.On the basis of mastering skull base reconstruction techniques,surgery via EEETTA is safe,effective and less invasive for suprasellar RCCs.

关 键 词：鞍上Rathke’s囊肿 神经内镜手术 扩大经鼻-鞍结节入路 疗效 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]