Rathke裂隙囊肿(RCC)是鞍区的良性上皮性病变,通常通过经蝶入路进行囊肿开窗和引流治疗。目前,指导患者选择手术治疗的证据有限.此外,很少有文献描述导致囊肿复发的因素。
作者对1995年至2016年在一个中心通过经蝶入路治疗的109例连续病理证实的RCC进行了回顾性分析。大多数病例(86.2%)涉及囊肿开窗术,排水,和部分壁切除。分析了长期结果。
共纳入100例患者中的109例手术,平均随访时间为67个月(范围3-220个月)。患者平均年龄为44.6岁(范围12-82岁),73%是女性。平均最大囊肿直径为14.7mm。88例(80.7%)为初级手术,21人(19.3%)为再次手术。术中脑脊液漏修补在53%的病例中进行,在再次手术病例中更为常见(71%vs48%,p<0.001)。没有新的神经功能缺损或围手术期死亡。两名患者(1.8%)发生术后CSF泄漏。短暂性尿崩症(DI)24例(22%),永久性DI6例(5.5%)。术后迟发性低钠血症7例(6.4%)。66例术前头痛患者中,61人中有27人(44.3%)报告术后改善,31人(50.8%)报告无变化。31例术前视力下降的患者,13例(48.1%)报告主观改善,12例(44.4%)报告视力不变。最初的术后MRI显示25%的病例有残留囊肿,75%的病例没有RCC的证据。29例(26.6%)影像学显示肾癌复发或进展。平均潜伏期为28.8个月。其中,只有10例(占109例病例的9.2%)有症状并接受了再次手术。
经蝶入路开窗引流术对有症状的病变是一种安全有效的干预措施。许多患者头痛和视力改善。RCC显示出可观的(尽管通常无症状)复发率,从而强制采取系列后续行动。尽管如此,由于垂体功能减退的风险,通常不建议完全切除RCC,DI,和脑脊液泄漏。
Rathke\'s cleft cysts (RCCs) are benign epithelial lesions of the sellar region typically treated via a transsphenoidal approach with cyst fenestration and drainage. At present, there is limited evidence to guide patient selection for operative treatment. Furthermore, there is minimal literature describing factors contributing to cyst recurrence.
The authors conducted a retrospective analysis of 109 consecutive cases of pathology-confirmed RCCs treated via a transsphenoidal approach at a single center from 1995 to 2016. The majority of cases (86.2%) involved cyst fenestration, drainage, and partial wall resection. Long-term outcomes were analyzed.
A total of 109 surgeries in 100 patients were included, with a mean follow-up duration of 67 months (range 3-220 months). The mean patient age was 44.6 years (range 12-82 years), and 73% were women. The mean maximal cyst diameter was 14.7 mm. Eighty-eight cases (80.7%) were primary operations, and 21 (19.3%) were reoperations. Intraoperative CSF leak repair was performed in 53% of cases and was more common in reoperation cases (71% vs 48%, p < 0.001). There were no new neurological deficits or perioperative deaths. Two patients (1.8%) developed postoperative CSF leaks. Transient diabetes insipidus (DI) developed in 24 cases (22%) and permanent DI developed in 6 (5.5%). Seven cases (6.4%) developed delayed postoperative hyponatremia. Of the 66 patients with preoperative headache, 27 (44.3%) of 61 reported postoperative improvement and 31 (50.8%) reported no change. Of 31 patients with preoperative vision loss, 13 (48.1%) reported subjective improvement and 12 (44.4%) reported unchanged vision. Initial postoperative MRI showed a residual cyst in 25% of cases and no evidence of RCC in 75% of cases. Imaging revealed evidence of RCC recurrence or progression in 29 cases (26.6%), with an average latency of 28.8 months. Of these, only 10 (9.2% of the total 109 cases) were symptomatic and underwent reoperation.
Transsphenoidal fenestration and drainage of RCCs is a safe and effective intervention for symptomatic lesions, with many patients experiencing improvement of headaches and vision. RCCs show an appreciable (although usually asymptomatic) recurrence rate, thereby mandating serial follow-up. Despite this, full RCC excision is typically not recommended due to risk of hypopituitarism, DI, and CSF leaks.