Ellens Nathaniel R, Miller Matthew C, Shafiq Ismat, Williams Zoe R, Vates G Edward
Departments of Neurosurgery.
Otolaryngology.
J Neurosurg Case Lessons. 2021 Apr 12;1(15):CASE2117. doi: 10.3171/CASE2117.
Rathke cleft cyst (RCC) has a recurrence rate of 10% to 22%, and preventing recurrence is challenging. For patients who experience persistent recurrence of RCC, placement of steroid-eluting bioabsorbable intrasellar stents has been rarely described. However, recurrences are often delayed, suggesting that dissolvable stents may not be successful long-term. The release of steroids in close proximity to the pituitary gland may also unintentionally influence the hypothalamic-adrenal-pituitary axis.
The authors present a case of a 66-year-old woman with a persistently recurrent RCC who underwent drainage of her cyst with placement of a nonabsorbable intrasellar stent in the form of a tympanostomy tube. After repeat transsphenoidal drainage of her cyst, a tympanostomy T-tube was placed to stent open the dural aperture. Postoperatively, the patient's condition showed improvement clinically and radiographically.
Placement of an intrasellar stent for recurrent RCC has rarely been described. Steroid-eluting bioabsorbable stents may dissolve before RCC recurrence and may have an unintentional effect on the hypothalamic-pituitary-adrenal axis. The authors present the first case of nonabsorbable stent placement in the form of a tympanostomy tube for recurrence of RCC. Additional studies and longer follow-up are necessary to evaluate the long-term efficacy of both absorbable and nonabsorbable stent placement.
拉克氏裂囊肿（RCC）的复发率为10%至22%，预防复发具有挑战性。对于RCC持续复发的患者，放置可释放类固醇的生物可吸收鞍内支架的情况鲜有报道。然而，复发往往延迟出现，这表明可溶解支架可能无法长期成功发挥作用。类固醇在垂体附近释放也可能无意中影响下丘脑 - 肾上腺 - 垂体轴。
作者报告了一例66岁女性，其RCC持续复发，接受了囊肿引流，并放置了鼓膜造口管形式的不可吸收鞍内支架。在对其囊肿进行重复经蝶窦引流后，放置了一个鼓膜造口T形管以撑开硬膜开口。术后，患者的临床和影像学状况均有改善。
关于为复发性RCC放置鞍内支架的情况鲜有报道。可释放类固醇的生物可吸收支架可能在RCC复发前就已溶解，并且可能对下丘脑 - 垂体 - 肾上腺轴产生无意的影响。作者报告了首例以鼓膜造口管形式放置不可吸收支架治疗RCC复发的病例。需要更多研究和更长时间的随访来评估可吸收和不可吸收支架放置的长期疗效。
