【作者】 卢刚； 赵元元； 楼林； 蔡学祥； 马杰；

【Author】 LU Gang;ZHAO Yuanyuan;LOU Lin;Department of Neurosurgery,Zhejiang People’s Hospital;

【机构】 浙江省人民医院神经外科；

【摘要】 目的:探讨垂体腺瘤合并Rathke囊肿的影像学特征及其治疗。方法:回顾性分析18例垂体腺瘤合并Rathke囊肿的影像学表现、组织学诊断和治疗结果。结果:18例患者中,男性7例,女性11例,平均年龄37.8岁。临床表现主要为头痛、视力障碍和内分泌症状。MRI扫描检查:7例病灶位于鞍内,11例同时累及鞍内和鞍上,Rathke囊肿均位于垂体腺瘤内。垂体腺瘤的T1-WI多呈低信号、等信号或混杂信号,T2-WI呈混杂信号或高信号,增强扫描后明显强化;Rathke囊肿T1-WI显示的信号多有不同,T2-WI呈混杂信号或高信号,但增强扫描后病灶均无强化。17例采用经鼻经蝶窦入路,1例经额下入路手术治疗,根据术中所见和术后的组织学检查均证实为垂体腺瘤合并Rathke囊肿。结论:囊壁无强化且囊腔通常位于瘤内中线部位是垂体腺瘤合并Rathke囊肿的特征性MR表现。垂体腺瘤合并Rathke囊肿术中应尽可能切除囊壁并避免采用脂肪移植填塞瘤腔,减少Rathke囊肿复发和术后并发垂体炎症的概率。更多还原

【Abstract】 Objective:To investigate the image features and surgical management of concomitant pituitary adenoma and Rathke’s cleft cyst.Methods:18 patients with concomitant pituitary adenoma and Rathke’s cleft cyst were retrospective analysised with their radiological findings and histopathological diagnosis and treatments.Results:There were 7 male and 11 female with average age of 37.8-year.The clinical signs were headache,vision abnormality and endocrine symptoms.MR of 7patients revealed an abnormal signal in the sellar region and 11 cases in both sellar and suprasellar areas,owing to the presence of a partial contrasting mass around cyst.The signal of pituitary adenoma was low or isointense on T1-weighted MR images and isointense or high intensity on T2-weighted MR images.The signal intensity of Rathke’s cleft cyst enclosed by adenoma was variable but none showed contrast enhancement.Surgery via the transsphenoidal route was performed on 17 cases and transfrontal approach was chosen for one patient.All the adenomas resected were diagnosed by histological examination and the pathological specimens also showed the features of Rathke’s cleft cyst on the basis of surgical findings.The diagnosis of concomitant pituitary adenoma and Rathke’s cleft cyst was histological verified.Conclusions:A non-enhancing cyst-like structure within the pars intermedia of pituitary adenoma usually located in the midline is a prominent MR image feature of coexisting pituitary adenoma with Rathke’s cleft cyst.Total resection of coexisted Rathke’s cleft cyst must be achieved and fat graft should be avoided during surgery because of high recurrence rate of Rathke’s cleft cyst and complicated hypophysitis.更多还原