CAJ | 학술논문

目的总结神经内镜下经眉弓锁孔入路切除Rathke囊肿的手术技术,并评价其疗效及优缺点.方法回顾性分析2012年5月至2014年10月南方医科大学南方医院神经外科收治的12例经病理证实的Rathke囊肿患者.临床表现包括头痛、视力障碍、多饮多尿及垂体功能障碍.CT及MRI提示鞍区囊性占位,最大平均直径为29.3 mm,其中完全位于鞍上者4例,位于鞍内-鞍上者8例.所有患者均采用全程神经内镜下经眉弓锁孔入路切除囊肿.结果 12例患者均达到囊肿内容物完全切除并切除部分囊壁,病理证实均为Rathke囊肿.术后所有患者术前症状均痊愈或改善,2例出现一过性多尿,术后3～4d出院.术后随访3～24个月,影像学检查均未见复发.结论经眉弓锁孔入路适用于完全位于鞍上型或主体位于鞍上的鞍内-鞍上型Rathke囊肿,该入路具有损伤小、恢复快、无脑脊液漏等并发症的优点,神经内镜技术可进一步减少创伤、扩大视野,尤其利于对囊肿在鞍内部分的观察与切除.
목적 총결신경내경하경미궁쇄공입로절제Rathke낭종적수술기술,병평개기료효급우결점.방법 회고성분석2012년5월지2014년10월남방의과대학남방의원신경외과수치적12례경병리증실적Rathke낭종환자.림상표현포괄두통、시력장애、다음다뇨급수체공능장애.CT급MRI제시안구낭성점위,최대평균직경위29.3 mm,기중완전위우안상자4례,위우안내-안상자8례.소유환자균채용전정신경내경하경미궁쇄공입로절제낭종.결과 12례환자균체도낭종내용물완전절제병절제부분낭벽,병리증실균위Rathke낭종.술후소유환자술전증상균전유혹개선,2례출현일과성다뇨,술후3～4d출원.술후수방3～24개월,영상학검사균미견복발.결론 경미궁쇄공입로괄용우완전위우안상형혹주체위우안상적안내-안상형Rathke낭종,해입로구유손상소、회복쾌、무뇌척액루등병발증적우점,신경내경기술가진일보감소창상、확대시야,우기리우대낭종재안내부분적관찰여절제.
Objective To summarize the surgical techniques of Rathke's cleft cyst resection via the fully endoscopic supraorbital trans-eyebrow keyhole approach and to evaluate its efficacy and the advantages and disadvantages.Methods Twelve patients with Rathke's cleft cyst confirmed by pathology at the Department of Neurosurgery,Nanfang Hospital,Southern Medical University from May 2012 to October 2014 were analyzed retrospectively.The clinical manifestations included headache,visual impairment,polydipsia,polyuria,and pituitary dysfunction.CT and MRI revealed the cystic masses in saddle areas.The maximum mean diameter was 29.3 mm,in which 4 lesions were located entirely on the suprasellar areas,and 8 were located on intrasellar suprasellar areas.All patients were treated with cyst resection via the fully endoscopic supraorbital trans-eyebrow keyhole approach.Results The cyst contents were all removed and part of cyst walls were resected in 12 patients.All were pathologically confirmed as Rathke's cleft cyst.The preoperative symptoms of all patients were cured or improved.Two patients had transient polyuria,and they discharged at 3 to 4 days after procedure.They were followed up for 3 to 24 months after procedure.No recurrence was found on imaging examinations.Conclusions The fully endoscopic supraorbital trans-eyebrow keyhole approach is suitable to intrasellar suprasellar Rathke's cleft cyst which is entirely located on the suprasellar area or the main body is located on the suprasellar area.This approach has the advantages of minimal invasiveness,rapid recovery and the absence of cerebrospinal fluid leakage and other complications.The neuroendoscopic technology may further reduce trauma and expand the field of vision,especially beneficial for the observation and removal of intrasellar cyst.