Cysts of the Sella Turcica

CYSTS OF THE SELLA TURCICA

緒言

　鞍部周辺の疾患は，視交叉症候および種々の内分泌症状を呈し，脳神経外科領域において極めて興味深いとともに，視力の回復の点で早期診断が重要な疾患である。

　すなわちPituitary adenoma, Craniopharyngioma，Meningioma, Glioma, Chordomaなどの腫瘍群やOpti—cochiasmatic arachnoiditis, Aneurysmなどの非腫瘍性のものがあり，これらの疾患は，その検査方法の普及と手術方法の発達に伴い早期診断，早期手術の症例が増えている。

We experienced two cases of intrasellar cyst which contained brownish-yellow fluid without tumor cells. Histological examination of the cyst wall revealed plentifull hemosiderin deposition, he-mosiderin ingested phagocytes, plasma cells, and lymphocytes in connective tissue without epithetial lining.

Case 1. This 29-years-old man was admitted to our department with chief complaints of sudden onset of headache and blurred vision. The headache had become severe in frontal area and increased markedly 2 days prior to admission. There were no symptoms suggesting of neurological and endocrin-ological dysfunction.

Visual examination were entirely normal except for myopia. The CSF were normal. The 17-KS, 17-OHCS and radioactive iodine uptake were all normal.

Skull roentgenograms showed minimal erosion of the posterior clinoid of the sella turcica. (Fig. 1.). Bilateral carotid arteriograms demonstrated upward and lateral displacement of both anterior cerebral arteries. (Fig. 2.). A pneumoencephalogram revealed a mass extending out of the sella. (Fig. 3, Fig. 4.).

Operation ; A thin walled cyst was found, which severely compressed both optic nerves and the chiasma upward. It occupied entire sella and ex-tend above. (Fig. 5.).

The fluid material within the cyst was brownish-yellow. The cyst was then opened widely and evacuated. The pituitary stalk was out of the vision and any solid tissue could not been found both within the cyst and its wall. The cyst wall was partially excised and coagulated.

The histological examination revealed no evidence of neoplastic tissue. The cyst wall had no epitherial lining and only composed of connective tissue. (Fig. 6.).

Case 2. A 35-years-old woman, she noted pachy loss of vision two months prior to admission. At that time she was at 4 months pregnant period, so she received artifical abortion, but bitemporal field defect remained unchanged.

Ophthalmological examination showed bitempo-ral hemianopsia. (Scotoma reratinum) (Fig. 7.). Optic fundi were normal, and visual acuity was 0. 3 on right, 0. 6 on the left. Blood count, urinalysis and serological tests were all normal. The CSFexamination was normal. Skull x-ray films showed minimal erosion of the sella turcica. (Fig. 8.). Bilateral carotid arteriograms demonstrated upward and lateral displacement of both anterior cerebral arteries. (Fig. 9.). A pneumoencephalogram revealed a mass expanding out of the sells. (Fig. 10.).

Operation ; Through a right transfrontal cranio-tomy, a large cyst with brown dome projecting between the optic nerves was found. Needle as-piration yielded 5 cc of thick brownish fluid. The roof of the cyst was excised.

The histological examination revealed no evidence of neoplastic tissue and a connective tissue capsule with no epithelial lining. (Fig. 11.).

Postoperative course ; The visual acuity of botheyes was strikingly improved 2 days after operation. Hemianopsia was completely disappeared.

Summary ; Two cases with sudden onset of visual disturbance were operated to find the cyst of the sella turcica with brownish-yellow fluid. The his-tological examination revealed plentiful hemosiderin ingested phagocytes, plasma cells and lymphocytes in the connective tissue without epithelial lining.

Though its etiology and pathogenesis may remain unclear, we believe that we should rather call these cases "Bleeding of the sells turciea" than the cyst of the sella turcica on the stand points of their histology and clinical course.