RESUMO
In cases of symptomatic Rathke's cleft cysts with headache, visual disturbance, and endocrinopathy, we choose operations. But, the effects of operations are different according to the symptoms. Recently, there are some reports of Rathke's cleft cysts with spontaneous involution, and we need to reconsider the surgical indication for symptomatic Rathke's cleft cysts. We also had two cases of suspected Rathke's cleft cysts with spontaneous disappearance. Taking these experiences into account, we may spend time on detecting the operative indication for symptomatic Rathke's cleft cysts with the symptom such as headache. But, we should evaluate pituitary function by hormone-loading tests immediately to consider the operative indication for cases with symptoms such as endocrine dysfunction.
Assuntos
Cistos do Sistema Nervoso Central/cirurgia , Hipófise/cirurgia , Cistos do Sistema Nervoso Central/complicações , Cistos do Sistema Nervoso Central/diagnóstico , Progressão da Doença , Feminino , Cefaleia/etiologia , Cefaleia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Regressão Neoplásica Espontânea , Hipófise/fisiopatologia , Resultado do TratamentoRESUMO
The authors reviewed their clinical experience with preoperative embolization of metastatic spinal tumors. Between October 2000 and September 2003, 20 patients (13 men and 7 women; average age 68.3 years, range 44-82 years) underwent 24 spinal operations for 22 spinal metastatic tumors. Nineteen spinal operations (79%) were planned preoperative embolization with polyvinyl alcohol particles. In 3 cases, there was no tumor stain. Fifty percent of the C4-T2 lesions and 76% of the T3-L3 lesions were embolized preoperatively. The level of lesions determined which embolization procedure should be used. With C7-T2 or sacral lesions, feeding arteries were superselectively catheterized, then particles were injected via a microcatheter. With T3-L3 lesions, selective catheterization of the corresponding segmental arteries was performed. Particles were injected via 4 or 5Fr catheters. No complications were encountered during embolization. Embolizing from the origin of the segmental arteries is effective for reducing intraoperative blood loss because feeding vessels in the anterior part of the spinal body are able to be embolized. Preoperative embolization is not a very complicated procedure and careful catheterization can avoid complications. Based on tumor histology, size of the spinal body, depth of the operative field and operative approach, preoperative embolization can be performed with positive results.