Fukushima T, Sakamoto S, Kimura H, Matsuda T, Tsugu H, Tomonaga M
Department of Neurosurgery, School of Medicine, Fukuoka University.
Noshuyo Byori. 1994;11(1):107-14.
Nine cases of symptomatic Rathke's cleft cyst are reported. Their most frequent signs and symptoms included headache, chiasmal syndrome and hypopituitarism, while one of the cases developed a sudden onset of headache and vomiting following diabetes insipidus. Endocrinological findings showed a decreased ACTH, gonadotropin and growth hormone more frequently while there were 2 cases of hyperprolactinemia and 1 case of diabetes insipidus. In a neuroradiological examination, a plain skull X-ray showed 5 cases of ballooning of the sella turcica, and a CT scan demonstrated a low to high density of the cyst and 2 cases of marginal enhancement of the cyst. MRI mostly demonstrated a well delineated mass at the sella extending mostly into the suprasellar region and a low to high intensity of the cyst in the T1-weighted image. Two cases were marginally enhanced after gadolinium DTPA administration. The pathological examination, done on 6 cases, showed either single or multiple layers of the epithelium which were mostly ciliated. The epithelium was positive in PAS and Alcian blue in all cases and a histochemical examination showed 3 cases to be positive in EMA and 2 cases positive in CEA. A resection of the cyst wall and an opening of the cyst is thus recommended in symptomatic cases. Therefore, the transsphenoidal approach should be the choice of treatment in an intra- and suprasellar extension of the cysts with sellar enlargement.(ABSTRACT TRUNCATED AT 250 WORDS)
报告了9例有症状的拉克氏裂囊肿。其最常见的体征和症状包括头痛、视交叉综合征和垂体功能减退，而其中1例在尿崩症后突然出现头痛和呕吐。内分泌学检查结果显示，促肾上腺皮质激素、促性腺激素和生长激素减少更为常见，同时有2例高催乳素血症和1例尿崩症。在神经放射学检查中，普通头颅X线显示5例蝶鞍膨隆，CT扫描显示囊肿密度从低到高，2例囊肿边缘强化。MRI大多显示蝶鞍处边界清晰的肿块，主要延伸至鞍上区域，在T1加权图像中囊肿信号强度从低到高。2例在给予钆喷替酸葡甲胺后边缘强化。对6例进行的病理检查显示，上皮为单层或多层，大多有纤毛。所有病例上皮对PAS和阿尔辛蓝均呈阳性，组织化学检查显示3例上皮膜抗原呈阳性，2例癌胚抗原呈阳性。因此，建议对有症状的病例切除囊肿壁并打开囊肿。因此，对于囊肿向鞍内和鞍上扩展且蝶鞍扩大的情况，经蝶窦入路应作为治疗选择。（摘要截短于250字）
