垂体脓肿的诊断和治疗(14例报告和文献复习)

目的:探讨垂体脓肿的临床特征和治疗。方法:回顾性分析14例垂体脓肿患者的临床表现、影像学特征、诊断和治疗,并结合文献进行分析。结果:14例患者中头痛13例,垂体功能低下6例,视力视野影响6例,多饮多尿3例,发热3例。MRI增强病灶均呈环状强化。11例经蝶手术治疗,3例经开颅手术。术后随访头痛缓解者10例,视力、视野改善者4例,尿崩者2例恢复正常,垂体功能低下者中4例恢复正常,3例开颅手术者中2例复发,再经蝶手术治愈。结论:应用常规CT和MR术前诊断垂体脓肿困难,对鞍区囊性病变应考虑到垂体脓肿的可能。及早手术、正确选择手术入路、围手术期合理应用抗生素和适当的对症治疗是治疗垂体脓肿的关键。

Diagnosis and Management of Pituitary Abscess

Aim:To explore clinical features and treatments of pituitary abscess.Methods:A retrospective analysis was done upon clinical presentations,imaging features,diagnosis and treatment in 14 cases of pituitary abscess.Results:Of 14 cases,headache was presented in 13 cases,hypopituiarism in 6 cases ,visual disturbance in 6 cases,fever in 3 cases,and polyuria in 3 cases.MR image revealed ring-enhancing pituitary lesion.All cases were treated surgically, by craniotomy in 3 and transsphenoidal approach in 11.Postoperatively,visual was improved in 4 cases, hypopituitarism was relieved in 4 cases and polyuria was disappeared in 2 cases.2 cases who underwent craniotomy were recurrent and cured via transsphenoidal approach.Conclusion:The preoperative diagnosis of pituitary abscess is difficult by using conventional CT and MRI.Cystic pituitary lesion differentiation should be considered the possibility of pituitary abscess. Appropriate surgical approach,proper perioperative antibiotics and symptomatic therapy are the keys to treatment of pituitary abscess.