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Neurological Surgery No Shinkei Geka Volume 23, Issue 11 （November 1995）

Neurological Surgery 脳神経外科 23巻11号（1995年11月発行）

Japanese English

症例

ラトケ嚢胞の感染による下垂体膿瘍 A Case of Pituitary Abscess Caused by Infection of Rathke's Cleft Cyst 佐藤雅春 ¹ , 松島豊 ¹ , 田口潤智 ¹ , 松本重人 ² , 巽千賀夫 ² , 尾崎正義 ³ , 花田正人 ⁴ , 早川徹 ⁵ Masaharu SATO ¹ , Yutaka MATSUSHIMA ¹ , Junji TAGUCHI ¹ , Shigeto MATSUMOTO ² , Chikao TATSUMI ² , Masayoshi OZAKI ³ , Masato HANADA ⁴ , Tohru HAYAKAWA ⁵ ¹市立豊中病院脳神経外科 ²市立豊中病院内科 ³市立豊中病院耳鼻咽喉科 ⁴市立豊中病院病理部 ⁵大阪大学脳神経外科 ¹Department of Neurosurgery, Toyonaka Municipal Hospital ²Department of Internal Medicine, Toyonaka Municipal Hospital ³Department of Otolaryngology, Toyonaka Municipal Hospital ⁴Department of Pathology, Toyonaka Municipal Hospital ⁵Department of Neurosurgery, Osaka University Medical School キーワード： Brain abscess , Diabetes insipidus , Hypopituitarism , Pituitary abscess , Rathke's cleft syst Keyword: Brain abscess , Diabetes insipidus , Hypopituitarism , Pituitary abscess , Rathke's cleft syst pp.991-995

発行日 1995年11月10日 Published Date 1995/11/10

DOI https://doi.org/10.11477/mf.1436901110

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Abstract 文献概要
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I．はじめに

　下垂体膿瘍は術前診断が難しいため治療が遅れることが多く，いまだに生命予後が非常に不良な疾患である．われわれはラトケ嚢胞の感染による下垂体膿瘍の稀な症例を経験したので報告し，文献的考察を加えた．

Pituitary abscess is relatively rare. Only about 80 cases have been reported. Preexisting lesions in pituit-ary fossa, such as pituitary adenoma, craniopharyn-gioma and Rathke's cleft cyst, are inclined to be com-plicated by infection more than the normal pituitary glands are.

We reported a case of pituitary abscess caused by in-fection of Rathke's cleft cyst. A 67-year-old male had general fatigue and loss of appetite 4 months before admission. On admission he was found to have diabetes mellitus, diabetes insipidus, and hypernatremia. These defects were controlled by medication but he gradually became comatose and febrile. CT and MRI revealed an intrasellar lesion with ring enhancement. Lumbar punc-ture demonstrated an increase of mononuclear cells and protein. Blood chemistry revealed a marked increase of CRP. He was operated on via the transsphenoidal approach, which revealed sphenoid sinusitis and abs-cess formation in the pituitary gland. Histological ex-amination of the surgical specimen revealed infection of Rathke's cleft cyst but the fluid in the cyst was sterile. By the drainage of the cyst and the use of antibiotics the patient became alert and signs of infection dis-appeared. He was discharged with a slight hypopi-tuitarism and returned to normal life.

Mortality rate of pituitary abscess is decreasing but is still high because of hypopituitarism and severe in-fection. Accurate diagnosis and operation are necessary. Transsphenoidal surgery is preferable for postoperative drainage of the abscess.