神经内镜下经蝶窦入路手术治疗垂体脓肿四例分析

目的 结合文献对4例垂体脓肿患者的发病原因、临床表现、影像学和内分泌功能特点、治疗方法及预后进行回顾总结.方法 与结果 2015年1月至2019年8月共治疗534例鞍区病变患者,其中4例为垂体脓肿,约占0.89％,原发性3例、继发性1例;临床表现为头痛、视物模糊和颞侧偏盲、乏力纳差等腺垂体功能减退症状,伴多饮多尿(2例)或短暂性发热(2例);MRI可见鞍区囊性占位性病变,囊壁呈典型均匀强化(4例);内分泌功能测定提示甲状腺功能减退症(4例)、肾上腺皮质功能减退症(3例)和性腺功能减退症(3例).术前经对症激素替代和头孢曲松抗感染治疗后,行神经内镜下经蝶窦入路垂体脓肿清除术;术后垂体功能恢复正常...

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Published in中国现代神经疾病杂志 Vol. 20; no. 3; pp. 204 - 209
Main Authors 刘小海, 李茗初, 陈革
Format Journal Article
LanguageChinese
Published 100053北京,首都医科大学宣武医院神经外科中国国际神经科学研究所 25.03.2020
Subjects
蝶窦
预后
脑脓肿
垂体
神经外科手术
Online AccessGet full text
ISSN1672-6731
DOI10.3969/j.issn.1672-6731.2020.03.012

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Abstract 目的 结合文献对4例垂体脓肿患者的发病原因、临床表现、影像学和内分泌功能特点、治疗方法及预后进行回顾总结.方法 与结果 2015年1月至2019年8月共治疗534例鞍区病变患者,其中4例为垂体脓肿,约占0.89％,原发性3例、继发性1例;临床表现为头痛、视物模糊和颞侧偏盲、乏力纳差等腺垂体功能减退症状,伴多饮多尿(2例)或短暂性发热(2例);MRI可见鞍区囊性占位性病变,囊壁呈典型均匀强化(4例);内分泌功能测定提示甲状腺功能减退症(4例)、肾上腺皮质功能减退症(3例)和性腺功能减退症(3例).术前经对症激素替代和头孢曲松抗感染治疗后,行神经内镜下经蝶窦入路垂体脓肿清除术;术后垂体功能恢复正常3例、遗留肾上腺皮质功能减退症1例(需终身激素替代治疗),随访3个月无复发迹象.结论 垂体脓肿早期可出现垂体功能减退症状,MRI以边缘强化囊性占位效应为特征;外科治疗推荐神经内镜下经蝶窦入路垂体脓肿清除术,患者多预后良好,复发率较低.
AbstractList 目的 结合文献对4例垂体脓肿患者的发病原因、临床表现、影像学和内分泌功能特点、治疗方法及预后进行回顾总结.方法 与结果 2015年1月至2019年8月共治疗534例鞍区病变患者,其中4例为垂体脓肿,约占0.89％,原发性3例、继发性1例;临床表现为头痛、视物模糊和颞侧偏盲、乏力纳差等腺垂体功能减退症状,伴多饮多尿(2例)或短暂性发热(2例);MRI可见鞍区囊性占位性病变,囊壁呈典型均匀强化(4例);内分泌功能测定提示甲状腺功能减退症(4例)、肾上腺皮质功能减退症(3例)和性腺功能减退症(3例).术前经对症激素替代和头孢曲松抗感染治疗后,行神经内镜下经蝶窦入路垂体脓肿清除术;术后垂体功能恢复正常3例、遗留肾上腺皮质功能减退症1例(需终身激素替代治疗),随访3个月无复发迹象.结论 垂体脓肿早期可出现垂体功能减退症状,MRI以边缘强化囊性占位效应为特征;外科治疗推荐神经内镜下经蝶窦入路垂体脓肿清除术,患者多预后良好,复发率较低.
Author 陈革
李茗初
刘小海
AuthorAffiliation 100053北京,首都医科大学宣武医院神经外科中国国际神经科学研究所
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CHEN Ge
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预后
脑脓肿
垂体
神经外科手术
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