RESUMO
An endoscopic endonasal approach was performed to remove an intra-suprasellar Rathke's cleft cyst. Rathke's cleft cyst are benign lesions, rarely diagnosed because they are often asymptomatic. To the best of our knowledge, at least 475 cases of Rathke's cleft cysts have been reported. They seem to arise from remnants of Rathke's pouch, an invagination of the stomodeum. A 52-year-old woman, complaining of bilateral frontal headaches, was operated on by using an endoscopic endonasal approach, for an intra-suprasellar tumor. The pre-operative diagnosis was non-functioning pituitary adenoma. Intra-operatively a creamy-coloured viscous tissue was found. After the removal of the cyst contents and of the capsule, the suprasellar structures were seen well. The chiasmatic cistern, the chiasm, the pituitary stalk and the pituitary gland were visualized with 0 and 30 degree endoscopes. The pathological findings showed a well-differentiated cuboidal epithelium. The diagnosis was Rathke's cleft cyst. No post-operative complications were observed. The endoscopic technique was particularly suitable in this case, both for the Rathke's cleft features and for an excellent outcome. The Rathke's cleft cyst was easily removed by suction and the cyst wall was entirely removed with curettes and pituitary punches. The hypophysis was distinguished from the cyst and was preserved. The surgical manoeuvres were all done under direct visual control. The absence of nasal packing and of breathing difficulties made comfortable the post-operative outcome. Thus, the endoscopic endonasal approach can be considered the favourite technique in case of either intra- and/or suprasellar Rathke's cleft cysts.
Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Endoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Cistos do Sistema Nervoso Central/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Cavidade Nasal , HipófiseAssuntos
Encéfalo/metabolismo , Microdiálise/normas , Hemorragia Subaracnóidea/metabolismo , Adulto , Velocidade do Fluxo Sanguíneo , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular , Espaço Extracelular/metabolismo , Humanos , Sensibilidade e Especificidade , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/fisiopatologia , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler Transcraniana , Vasoespasmo Intracraniano/diagnóstico , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/metabolismoRESUMO
This report describes a case of fibrous dysplasia of the skull, involving the right parietal, occipital and temporal bones, with complication caused by entrance of air into the extradural and subcutaneous spaces with intracranial hypertension. This type of complication has never been reported in the literature.
Assuntos
Displasia Fibrosa Óssea/complicações , Pseudotumor Cerebral/etiologia , Adulto , Displasia Fibrosa Óssea/diagnóstico por imagem , Displasia Fibrosa Óssea/cirurgia , Humanos , Masculino , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
The authors intend to define the treatment of cerebrospinal fluid otorrhea according to the type of fracture involving the petrous bone. Fractures of the petrous bone causing cerebrospinal fluid otorrhea can be classified in two types: (1) fractures extending anteriorly toward the anterior foramen lacerus; (2) fractures extending posteriorly through the labyrinth to the internal auditory meatus. The former usually resolve spontaneously; the latter, because of different anatomy and embryogenesis, require a surgical procedure using a translabyrinthine approach.
