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鞍内脓肿转变为拉克氏囊肿(作者译)

[Intrasellar abscess into a cyst of the Rathke's pouch (authors' translation)].

作者信息

Gomez Perun J, Eiras J, Carcavilla L I

出版信息

Neurochirurgie. 1981;27(3):201-5.

PMID:7312094
Abstract

The authors report a case of abscessified cyst the pouch of Rathke similar to that published by Obenchain in 1972 and Menault in 1979. The clinical picture was determined for recurrent meningeal burst without signs of intracraneal pressure nor optochiasmatic involvement. The spinal fluid showed pleocitosis and hyperprotein. No bacterial growth was demonstrated. Antibiotic therapy had no effect on the clinical follow-up. C.T. was unable to show the location of the lesion evidenced by pneumocisternography. Though a subfrontal approach was emptied an abscess in the sella turcica, with walls formed for tissue of he Rathke's pouch. A few months later a new meningeal burst occurred and a recurrence of the abscess was confirmed at operation. The follow-up was of progressive neurological deterioration with exitus letalis a few days later. Abscessified sella tumors ahd been rarely reported in the literature : chromophobe adenoma appeared most frequently and only in 3 cases within craniopharyngiomas. Diagnostic difficulties arise from the lack of focal symptoms and from the failure of some neuroradiological procedures to demonstrate the lesion. The high risk of recurrence and the poor prognosis of these abscess will be discused. Although a similar embryological origin the cyst the Rathke's cleft and the craniopharingiomas present pathological aspects that made each other differenciable.

摘要

作者报告了一例Rathke囊袋脓肿化病例,类似于1972年Obenchain及1979年Menault所发表的病例。临床表现为反复出现的脑膜破裂,无颅内压升高迹象,也未累及视交叉。脑脊液显示细胞增多和蛋白含量增高。未发现细菌生长。抗生素治疗对临床随访无效。CT未能显示气脑造影所证实的病变位置。尽管采用额下入路排空了蝶鞍内的一个脓肿,其壁由Rathke囊袋组织构成。几个月后,再次出现脑膜破裂,手术证实脓肿复发。随访显示神经功能逐渐恶化,数日后死亡。文献中很少报道蝶鞍脓肿化肿瘤:嫌色性腺瘤最为常见,且仅在颅咽管瘤中有3例。诊断困难源于缺乏局灶性症状以及某些神经放射学检查未能显示病变。将讨论这些脓肿的高复发风险及不良预后。尽管Rathke裂囊肿与颅咽管瘤有相似的胚胎学起源,但它们的病理表现有所不同。

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