自然経過で縮小した症候性ラトケ囊胞と考えられる2例の治療経験からみた手術適応の検討

Surgical Indication for Two Cases of Symptomatic Rathke's Cleft Cysts with Spontaneous Involution

Ⅰ．はじめに

　ラトケ囊胞はその多くが無症候性であるが，進行性に増大した場合は頭痛，視力・視野異常，内分泌障害といった症状を呈することがある．症候性の場合，手術が選択されるが，その治療効果については症状により違いがある．また，近年，自然経過で縮小するラトケ囊胞と考えられる症例も散見されてきており^2,7-9)，手術適応を再考する余地がある．今回，われわれも2例の縮小するラトケ囊胞と考えられる症例を経験したので，近年の文献的考察を加え，その手術適応についての検討を報告する．

　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.