el-Mahdy W, Powell M
Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, England.
Neurosurgery. 1998 Jan;42(1):7-16; discussion 16-7. doi: 10.1097/00006123-199801000-00003.
This is a retrospective study of a series of 28 Rathke's cleft cysts operated on transsphenoidally that was undertaken for the following reasons: 1) to study the presentation, with particular reference to hormonal and visual disturbances; 2) to study postoperative improvements in endocrine function and vision; 3) to record postoperative complications; and 4) to assess the efficacy of a minor modification of the standard transsphenoidal surgical technique, whereby the cyst is allowed to drain directly into the sphenoid air sinus without fossa floor repair when there is no intraoperative cerebrospinal fluid leak.
A retrospective study was made of case notes, radiological findings, and operative notes in the series.
There were 16 female and 12 male patients, with a mean age of 45 years. Endocrine disturbance was the most common presentation (50%), followed by headaches (32.1%) and visual impairment (14.3%). Neuroophthalmological assessment showed central visual acuity and field deficits in 32.1 and 44.6% of eyes, respectively. Biochemically, 85.7% of patients showed hormonal disturbances. Magnetic resonance imaging was used for 84.7% of cases, and 60.7% of cases showed suprasellar extension. Four magnetic resonance imaging patterns were noted. All cases were operated on transsphenoidally. Postoperative complications included cerebrospinal fluid rhinorrhea (7.1%), diabetes insipidus (3.6%), and meningitis (3.6%). Recovery of visual acuity and field was seen in 66.6 and 68% of eyes, respectively. Postoperative prolactin levels declined to normal or nearly normal values in 62.5% of cases, 20% of cases with low preoperative gonadotrophin levels achieved normal levels, and 15.4% of cases with preoperative pan-hypopituitarism achieved normal serum cortisol levels postoperatively. Within the study period there were no recurrences; although a relatively short time interval is presented for this series, a patient with a similar lesion operated on by the same method 7 years previously remains well, without radiological evidence of recurrence.
Although comparatively rare and benign lesions, Rathke's cleft cysts are an important cause of hormonal and visual disturbances. Transsphenoidal surgery is safe and efficacious and leads to excellent improvement of function in the majority of cases. The surgical modification described seems safe and satisfactory and is extremely easy to perform.
这是一项对28例经蝶窦手术治疗的拉克氏裂囊肿的回顾性研究，进行该研究的原因如下：1）研究临床表现，尤其关注激素及视觉障碍；2）研究术后内分泌功能及视力的改善情况；3）记录术后并发症；4）评估对标准经蝶窦手术技术进行的一项微小改良的疗效，即在术中无脑脊液漏时，允许囊肿直接引流至蝶窦气房而不进行颅底修复。
对该系列病例的病历、影像学检查结果及手术记录进行回顾性研究。
患者中女性16例，男性12例，平均年龄45岁。内分泌紊乱是最常见的表现（50%），其次是头痛（32.1%）和视力损害（14.3%）。神经眼科评估显示，分别有32.1%和44.6%的眼睛存在中心视力和视野缺损。生化检查方面，85.7%的患者存在激素紊乱。8项研究中有2项（25%）采用了磁共振成像，60.7%的病例显示有鞍上扩展。观察到4种磁共振成像模式。所有病例均行经蝶窦手术。术后并发症包括脑脊液鼻漏（7.1%）、尿崩症（3.6%）和脑膜炎（3.6%）。分别有66.6%和68%的眼睛视力和视野得到恢复。62.5%的病例术后催乳素水平降至正常或接近正常水平，20%术前促性腺激素水平低的病例达到正常水平，15.4%术前全垂体功能减退的病例术后血清皮质醇水平恢复正常。在研究期间无复发情况；尽管该系列的时间间隔相对较短，但1例7年前采用相同方法手术的类似病变患者情况良好，无复发的影像学证据。
拉克氏裂囊肿虽然相对罕见且为良性病变，但却是激素及视觉障碍的重要原因。经蝶窦手术安全有效，在大多数病例中能使功能得到显著改善。所描述的手术改良似乎安全且令人满意，而且极易实施。
