Yoshimurak Kazuhiro, Kubo Shigeki, Nagashima Munenori, Hasegawa Hiroshi, Tominaga Shinsuke, Yoshimine Toshiki
Department of Neurosurgery, Iseikai General Hospital.
No Shinkei Geka. 2006 Jun;34(6):605-10.
Drainage by fenestration of the cyst wall via the transsphenoidal apporach is the most commonly used treatment for symptomatic Rathke's cleft cyst (RCC). The same procedure is usually adopted for recurrence of RCC. We have encountered a case of secondary empty sella syndrome presented with visual field defects after repeated surgery for RCC. Secondary empty sella syndrome following the surgery of RCC is rare. The condition was explained by the mechanism that the optic nerve adhered to the cyst wall and it was tethered downward as the cyst shrank after the surgery. We treated the patient via the endonasal endoscopic transsphenoidal approach by placing holed silicone plates under the sellar floor to elevate the sellar contents and the optic nerve. Silicone plate is hard enough to support the sella and the small holes on it would facilitate drainage of the cyst contents. This method has proved useful as chiasmapexy for secondary empty sella syndrome after the surgery of RCC.
经蝶窦入路通过囊肿壁开窗引流是有症状的拉克氏裂囊肿（RCC）最常用的治疗方法。RCC复发时通常采用相同的手术方法。我们遇到一例RCC反复手术后出现视野缺损的继发性空蝶鞍综合征病例。RCC手术后继发空蝶鞍综合征很罕见。这种情况的原因是视神经附着于囊肿壁，手术后囊肿缩小，视神经被向下牵拉。我们通过鼻内镜经蝶窦入路，在蝶鞍底部放置带孔硅胶板以抬高蝶鞍内容物和视神经来治疗该患者。硅胶板足够坚硬以支撑蝶鞍，其上面的小孔有助于囊肿内容物引流。这种方法已被证明对RCC手术后继发性空蝶鞍综合征的视交叉固定术有用。
