Ratke Cheek Cleft Cyst Surgery

The Rathke's fissure cyst is a congenital cyst derived from the residual epithelial cells of the embryonic craniopharyngioma. At 4 weeks of embryos, the outer embryonic layer cells above the original mouth bulged upward to form a Rathke sac, which closed into the craniopharynx tube 7 weeks before the embryo, and the anterior wall formed a pituitary pit, which later developed into the anterior pituitary; Less developed into the middle pituitary. Shanklin (1949) found 22 cases of residual cavities between the two tissues in 100 normal autopsies. Of these, 13 formed small cysts with cystic fluid without clinical symptoms, which was called Rathke's fissure. Since then, some authors have discovered that the cyst formed by this fissure can gradually increase, causing compression of the surrounding structure and clinical symptoms, which is called symptomatic Rathke's fissure cyst. E1-Mahdy (1998) reported 28 cases, in which single-layer columnar or cubic epithelium accounted for 71.4%, pseudostratified squamous epithelium accounted for 17%, mixed epithelial cells accounted for 7%; intracapsular liquid transparent yellowish accounted for 21.4%, sticky It is 60.7% thick and turbid or mucous, and its color varies from green to brown. In addition, some authors report that their contents resemble epithelioid cysts. Treatment of diseases: craniopharyngioma Indication Because the disease is clinically and imagingly similar to the cystic pituitary tumor or craniopharyngioma that develops in the sella or slightly above the saddle, the surgical indications are the same as the upper two tumors in the site. Occasionally found that small asymptomatic people can not surgery. Contraindications 1. Nasal infection or chronic sinusitis, mucosal edema and congestion, prone to intracranial infection after surgery. 2. If the adult or sphenoid sinus is not well-formed, if the transsphenoidal approach is necessary, the bone in front of the sella should be ground with a micro-drill under the X-ray TV fluoroscopy. 3. The sphenoid sinus is over-vaporized, and the optic nerve and internal carotid artery can be exposed to the sphenoid sinus mucosa, which is easy to cause damage during operation. 4. Coronal CT scan showed that the tumor mass in the saddle and the sella was dumbbell-shaped, indicating that the saddle septum was small, and the transsphenoidal surgery was not easy to reach the saddle, and the saddle tumor was not easy to be seen after the saddle tumor was removed. Drop into the saddle during intracranial compression. 5. The tumor on the saddle is larger or extends to the anterior, middle, and posterior fossa. 6. The upper part of the tumor is larger, and the visual field of view is seriously damaged. The transsphenoidal surgery can not perform full optic nerve decompression, and the postoperative visual field recovery is not as good as transcranial microsurgery. Preoperative preparation 1. Endocrine examination includes a comprehensive determination of various endocrine hormones in the pituitary gland. 2. Imaging examination In addition to the common and multi-trajectory tomograms of the sella, thin-slice CT and MRI scans of the sella should be performed where possible. 3. Drug preparation has obvious pituitary dysfunction, appropriate replacement therapy before surgery, generally given dexamethasone or prednisone for 2 to 3 days. 4. Repeat the intranasal rinsing of the patient several days before the operation, or periodically add antibiotic solution. The nose hair was cut off 1 day before the operation, and washed, and the antibiotic solution was added dropwise. Surgical procedure 1. The earliest literature reports mostly use transcranial approach, and gradually enter the sphenoid sinus approach. Almost all of E1-Mahdy's (1998) and other large-scale case reports use transsphenoidal approach. 2. Most of the lesions seen during the operation were cystic lesions in the sella, and the cyst wall was partially removed after the cyst fluid was removed. Most authors advocate transsphenoidal approach to open the saddle dura mater and bone window, do not fill the fascia with fascia or fat, do not repair the saddle bottom, so that the cystic fluid continues to secrete into the sphenoid sinus, so as to avoid recurrence; It is necessary to keep the arachnoid membrane intact during the operation. If the membrane is ruptured, it is necessary to fill the saddle with fascia or fat to avoid cerebrospinal fluid leakage after operation. However, this treatment will inevitably lead to recurrence of the disease.

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