| Part I: analysis of MRI characteristics of Rathke cleft cystsObject: To observe the effects of microsurgery via transnasal sphenoidal approach of Rathke’s cleft cyst resection in patients with on MRI characteristics(Rathke’s cleft cyst of the location, size, cyst signal, intracystic nodules, posterior pituitary lobe(PPBS, posterior pituitary bright spot) combined with postoperative pathological shown in Rathke’s cleft cyst inflammatory infiltration, surgical treatment and hormone levels, analysis the MRI features and Rathke’s cleft cyst inflammatory infiltration between and contact, to explore the characteristics of Rathke’s cleft cyst.Method: We retrospectively reviewed 45 cases involving patients with RCCs treated via a transsphenoidal approach in Fuzhou General Hospital of Nanjing Military Comm,from 2010-1-1 to 2016-1-1, the standards:(1). Proved to be Rathke’s cleft cyst by intraoperative findings combined with pathology, not with pituitary tumors or other sellar lesions, no primary endocrine disease such as primary thyroid function hyperfunction or Cushing’s disease);(2) without radiotherapy or chemotherapy before, and were surgery by the same surgeon;(3) the clinical data of the preoperative and postoperative complete. To observe the location, intracystic nodules, MRI signal, the posterior pituitary lobe(PPBS) in MRI of 45 cases, in order to find the MRI characteristics.and read pathological results of these cases,try to find the relationship between PPBS and Inflammatory infiltration of Rathke’s cleft cyst.Results:(1)45 cases of Rathke cyst, 12 cases were totally in the saddle, 33 cases were both in and upside of the saddle.(2)Signal in T1 WI signal: 18 cases of iso-T1 signal, 16 cases of short-T1 signal, long-T1 signal in 9 cases, 2 cases appear statified phenomenon(one case : upper long-T1 signal, the lower part iso-T1 signal, the other : upper iso-T1 signal, the lower part short-T1 signal,); T2 WI signal: 5 cases of iso-T2 signal, 27 cases with long-T2 signal and short-T2 signal in 11 cases, 2 cases appeared stratification(one case :upper long-T2 signal, lower part short-T2 signal, the other case: upper long-T2 signal, lower part short-T2signal).(3)In 45 cases, PPBS(+) in 10 cases, PPBS(-) in 30 cases, lower than normal people and patients with pituitary tumors [1].with age, sex, location, size of the cyst was not statistically different. In the 31 cases which had rereaded pathology, 2 of the 10 cases with PPBS(+) were inflammatory infiltrated; 14 cases of 21 cases with PPBS(-) were inflammatory infiltrated, the comparison was statistically significant.(4)20 of the 45 cases were finded with intracyst nodules,it may be see in diffirent MRI sequence and it has various shape.Conclusions:(1)the positive rate of PPBS in Rathke’s cleft cyst patients was significantly lower than that in the patients with pituitary adenomas and normal people, and its lower rate may be related to the inflammatory infitration of Rathke cysts.(2) Intracystic nodul of is a more specific expression of the specific performance of the preoperative diagnosis of AIDS to help.Part two: the operation treatment of Rathke’s cleft cyst via transnasal sphenoidal approachObjective: patients of Rathke’s cleft cyst via transsphenoidal surgery were sellected, to analysis the effect of surgery and try to find the relationship with MRI( the size of the cyst, T1 signal, T2 signal, PPBS), and with the extent of resection.Methods: 45 cases of Rathke’s cleft cyst,the same with part one,were retrospectively collected,date from 2010-1-1 to 2016-1-1. Based on the size of the cyst,the groups are divided into 3 groups(Rathke’s cleft cyst diameter <10mm pouch divided into small group, 10-30 mm diameter divided into large cyst group, the diameter >30mm for huge cyst group).And PPBS display case for the PPBS(+) group, PPBS not display for the PPBS(-) group. To analysis of the effect and the relationship of two groups of surgical resection respectively with the operation effect.Results:(1)18 cases of preoperative headache, 16 cases were improved after the surgery; dizziness symptoms occurred in 13 cases, 10 cases improved obviously after operation,; 12 cases with impaired vision symptoms, 9 cases were improved after operation,; 3 cases polydipsia and 2 cases significantly improved postoperatively, 1 cases of menopausal symptoms has not yet been restored after; lactation symptoms occurred in 1 cases, no postoperative lactation, fatigue symptoms occurred in 3 cases, 2 cases improved obviously after. There were no significant difference in the size of the cyst, the remnant of the cyst after operation, the size of the cyst and PPBS, the size of the cyst and the leakage of cerebrospinal fluid(CSF) in the postoperative cerebrospinal fluid(P>0.05).Conclusion: surgery is effective in relieving symptoms, postoperative patients of PPBS(-) are more likely to be diabetes insipidus than PPBS(+).Part three: The study on the preoperative and postoperative changes of the Rathke’s cleft cyst hormone levelsObjective: To observe the pituitary endocrine hormone level pre- and postoperative(1 day,7 days after surgery, individually) single hormone levels and total hormone level,try to find how the hormone levels change.Methods: 17 cases of postoperative Rathke’s cleft cyst were collected,date from 2010-1-1 to 2016-1-1,which were tested hormone level in the early morning 7:00-9:00 before operation and1 day and 7 day after the surgery. Statistics using SPSS16.0, P < 0.05 has statistical significance, alpha =0.05 as a significant test level.Results:(1)The level of TSH before and 1 day after operation, before and after the seven days 7 were significant different(P < 0.05),but 1 day after operation and 7 days after operation had no significant difference(P > 0.05);(2)The level of PRL before and 1 day after surgery had statistical difference(P < 0.05), preoperatively and postoperatively 7 day, preoperatively 1 day and preoperatively 7 days had no significant difference.(3)LH level preoperative and postoperatively 1 day, before and 7 days after had statistical difference(P < 0.05).Conclusion: Rathke’s cleft cyst can partly affects the hormone level,and surgery can be helpful to resume pituitary endocrine function. The total hormone trended to rise after surgery. |
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