原发性垂体柄占位性病变的影像学特点和手术入路选择  

Image characteristics and operation approaches of the pituitary stalk space occupying lesions

作　　者：宋涛[1] 孙炜[1] 王成伟[1] 朱礼峰[1] 郝晓光[1] 孙金龙[1] 孟庆虎[1] 

机构地区：[1]山东大学第二医院神经外科,山东济南250032

出　　处：《山东大学学报（医学版）》2004年第2期189-191,共3页Journal of Shandong University:Health Sciences

摘　　要：目的:探讨垂体柄占位性病变的磁共振成像(magnetic resonance imaging,MRI)特点及其对手术入路选择的指导意义。方法:对17例患者行MRI检查,总结病变的具体位置、形态、信号以及与周围结构的关系;经翼点入路手术5例,其中1例术后放射治疗,经单侧鼻腔-蝶窦入路手术10例,单纯放射治疗2例。结果:Rathke's囊肿14例,MRI显示垂体柄呈球形或条索状增粗,T1呈等、低信号,T2呈高信号,强化均匀一致;生殖细胞瘤3例,T1、T2呈等信号,强化明显。经翼点入路Rathkes囊肿全切除1例,次全切除3例,生殖细胞瘤大部切除1例;经单侧鼻腔-蝶窦入路次全切除14例。结论:MRI可以诊断Rathkes囊肿,并指导手术入路的选择。鞍内、鞍上囊性病变适合经鼻蝶入路手术,鞍上囊实性或实性病变适合经翼点入路手术。Objective:To investigate the MRI features and the operation approaches of the pi- tuitary stalk space occupy lesions.Methods:The position,form,signal,and the relationship with sur- rounding structure of the lesions in 17 patients were studied through MRI.Fifteen patients were given operations,5 with Pterional approach and 10 with Transnasal Sphenoidal approach.The other 2 patients received with radiation therapy.Results:Fourteen patients were diagnosed as Rathke’s cyst,with e- qual and low signal on T1 and high signal on T2,and the lesion envelope was enhanced after rein- forcement.Three patients were diagnosed as Germinoma,with equal signal on T1 and T2,and the le- sions were enhanced completely.Conclusion:Rathke’s cyst can be diagnosed with MRI,and through which the appropriate operation approach can be selected.Transphenoid approach is fit for Cyst lesions in-sellar or up-sellar,and Pterional approach is fit for entity and cyst lesions up-sellar.

关 键 词：垂体柄 磁共振成像 Rathke’s囊肿 手术入路 

分 类 号：R742[医药卫生—神经病学与精神病学] R445.2[医药卫生—临床医学]