Fujiwara M, Bitoh S, Hasegawa H, Ohtsuki H
No Shinkei Geka. 1984 Mar;12(3 Suppl):331-7.
Intrasellar arachnoid cyst is very rare. We report a case of intrasellar arachnoid cyst and review 15 cases which were previously reported. A 58-year-old male was admitted for evaluation of visual disturbance on April 24, 1981. Neurological examination revealed bilateral decreased visual acuity, optic atrophy and bitemporal hemianopsia. X-ray film of the skull showed a balloon-shaped sella turcica with thinning of the cortex of the sella floor. Axial and coronal CT scan showed a cystic lesion with water-density occupying the intrasellar and suprasellar region. After administration of contrast medium, no enhancement was noted. Bilateral carotid angiographies demonstrated that the carotid siphons were stretched and displaced laterally, the A1 portions of the anterior cerebral arteries were raised. Pneumoencephalography revealed the upward displacement of the floor of the third ventricle indicating the presence of the suprasellar mass. On May 7, 1981, the sella turcica was reached via the transsphenoidal rhinoseptal approach. A cyst with a white colored thin wall which contained water-like fluid was encountered, and a biopsy was taken of the cyst wall. The roof of the cyst pulsated downward and ruptured spontaneously. Cerebrospinal fluid flowed out. The cavity was filled with muscle and adipose tissue. Postoperative course was uneventful during the first few days and the visual disturbance improved. On the fourth postoperative day cerebrospinal fluid rhinorrhea occurred, but it subsided in nine days. The patient was discharged on June 26 with satisfactory improvement of visual field and visual acuity. Histological examination of the biopsied specimen revealed arachnoid membrane consisting of collagen fibers and scattered cells. Symptoms, signs and radiological findings of the intrasellar archnoid cyst are similar to that of various sellar lesions including pituitary adenoma, craniopharyngioma and the other space occupying mass in the sellar region. Intrasellar arachnoid cysts can be treated by a transsphenoidal approach as well as a subfrontal approach with craniotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
鞍内蛛网膜囊肿非常罕见。我们报告一例鞍内蛛网膜囊肿病例，并回顾先前报道的15例病例。一名58岁男性于1981年4月24日因视力障碍入院评估。神经系统检查发现双侧视力下降、视神经萎缩和双颞侧偏盲。颅骨X线片显示蝶鞍呈气球状，蝶鞍底部皮质变薄。轴位和冠状位CT扫描显示一个水样密度的囊性病变占据鞍内和鞍上区域。注入造影剂后未见强化。双侧颈动脉血管造影显示颈动脉虹吸部被拉伸并向外侧移位，大脑前动脉A1段抬高。气脑造影显示第三脑室底部向上移位，提示鞍上有占位性病变。1981年5月7日，经经蝶窦鼻中隔入路到达蝶鞍。发现一个薄壁呈白色的囊肿，内含水样液体，并对囊肿壁进行了活检。囊肿顶部向下搏动并自发破裂。脑脊液流出。腔内填充肌肉和脂肪组织。术后头几天病情平稳，视力障碍有所改善。术后第四天出现脑脊液鼻漏，但九天后停止。患者于6月26日出院，视野和视力有满意改善。活检标本的组织学检查显示蛛网膜由胶原纤维和散在细胞组成。鞍内蛛网膜囊肿的症状、体征和影像学表现与包括垂体腺瘤、颅咽管瘤及鞍区其他占位性病变在内的各种鞍区病变相似。鞍内蛛网膜囊肿可通过经蝶窦入路以及额下入路开颅手术进行治疗。（摘要截选至250词）
