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DOI: 10.1055/s-0035-1547672
Postoperative reduction of cystic remnants of pituitary gland lesions
Objective: In this clinical case report we want to describe the course of three patients suffering of cystic lesions of the pituitary gland and shrinkage of postoperative remnants.
Patients and Methods: We evaluated the case of three patients treated with a cystic lesion of the pituitary gland in our neurosurgical department. Two patients suffered a Rathke's clef cyst and one patient a recurrent craniopharyngioma. Two patients were treated via a transsphenoid approach and one via a transcranial approach. The leading symptoms were vision impairment, fatigue and exhaustion, endocrine dysfunction and in one case diabetes insipidus. The patients had a pre-surgical MRI study. MRI studies were also performed on follow up. An endocrinological workup was performed before and after surgery for every patient. The patient treated because of the recurrent craniopharyngioma underwent two surgical interventions and one stereotactic radiation before he presented himself in our department. The two patients with a Rathke's clef cyst were not treated before. In one case of Rathke's clef cyst, the patient suffered a HIV Infection witch was treated sufficient with antiretroviral medication and a virus load below detection.
Results: After the surgery every patient had a remnant in the follow up MRI study three months after surgery. The patient with the HIV infection had a CT scan after surgery, which showed initially a good decompression of the cystic lesion. After the first three months no size reduction was visible in the imaging study. The size reduction was visible in the follow up MRI studies between 6 months and one year after surgery.
Conclusion: In this small study we were not able to determine factors associated with long term size reduction of remnants of cystic lesions of the pituitary gland. In the literature, size reduction of Rathke's cleft cysts is described in several cases, but no case of shrinkage of recurrent craniopharyngioma remnants was described before.