摘要
目的 探讨Rathke囊肿相关性头痛的特点及危险因素,为术前评估头痛与Rathke囊肿的相关性提供依据.方法 回顾性分析2010年1月至2015年12月大连医科大学附属第二医院神经外科收治的30例经术后病理确诊为Rathke囊肿患者的临床资料.根据手术对头痛的有效性进行分组,分为Rathke囊肿相关性头痛组（18例）和对照组（12例）,并对各组资料进行统计学对比分析.结果 Rathke囊肿相关性头痛部位主要位于前额及眶后13例,位于颞侧3例,同时伴有前额及颞侧各2例,无弥漫性头痛.单因素分析显示,性别、年龄、头痛家族史、囊肿体积及磁共振T2信号强度的组间差异无统计学意义（P＞0.05）.术前垂体功能紊乱（P=0.009）、磁共振T1高信号（P=0.008）、术前视力视野障碍（P =0.024）及囊肿周围环形强化（P =0.008）的组间差异具有统计学意义.经过Logistic多因素回归分析显示,术前垂体功能紊乱（OR=0.069,P=0.046,95％ CI：O.005～0.905）和囊肿周围环形强化（OR=12.779,P=0.049,95％ CI：1.010 ～161.691）是Rathke囊肿相关性头痛的独立危险因素.结论 Rathke囊肿相关性头痛的部位常位于前额及颞部,头痛机制复杂,术前垂体功能紊乱、MRI环形强化与头痛关系密切,精确的术前评估有利于提高手术疗效.
Objectives To explore the characteristics and risk factors of headaches associated with Rathke cleft cyst （RCC） and to provide evidence for evaluating the correlation between RCC and headaches preoperatively.Methods The clinical data of 30 patients,who were admitted to Department of Neurosurgery,the Second Affiliated Hospital of Dalian Medical University from January 2010 to December 2015 and diagnosed with RCC based on postoperative pathological examination,were collected and retrospectively analyzed.The patients were separated into 2 groups：a group of headaches associated with RCC （n =18） and a group of controls （n =12） based on the degrees of headache relief following surgical therapy.Clinical data of the two groups were statistically compared.Results RCC-associated headaches were reported in the forehead （13 cases）,temporal areas （3 cases） and both areas （2 cases）.None of them presented with diffuse headache.Univariate analysis showed that there was no significant difference between the two groups in sex,age,family history,tumor volume and the signal intensity on T2-weighted MRI image （P 〉 0.05）.Pituitary dysfunction （P =0.009）,hyper-intensity on T1-weighed MRI image （P =0.008）,visual deficiency （P =0.024） and the ring-enhancement on MRI （P =0.008） had significant difference between the two groups.By means of multivariate logistic analysis,preoperative pituitary dysfunction （OR =0.069,P =0.046,95% CI：0.005-0.905） and ring-enhancement on MRI （OR =12.779,P =0.049,95% CI：1.010-161.691） were determined independent risk factors for headache associated with RCC.Conclusions Headaches associated with RCC appear to affect the forehead and temporal areas with complex mechanisms.Pituitary dysfunction and ring-enhancement on MRI may have close correlation with headache.Adequate preoperative evaluation could help improve the surgical effect.
出处
《中华神经外科杂志》
CSCD
北大核心
2017年第2期160-163,共4页
Chinese Journal of Neurosurgery
