经蝶窦鞍内手术严重和罕见并发症分析

目的 探讨经蝶窦鞍内手术严重和罕见并发症的原因和预防措施。方法 分析1962－2001年3月间200例经蝶窦鞍内手术，发生严重和罕见并发站的16例临床资料，探讨其发生原因与预防方法。结果 16例发生严重和罕见并发症（8％），其中死亡4例（4％），严重出血8例（4％），视力恶化2例（1％），精神障碍2例（1％），癫痫持续状态1例（0．5％），剧烈头痛1例（0．5％），脑组织损伤2例（1％）。结论 经蝶窦鞍手术与经颅手术相比损伤明显减少，但仍可发生多种并发症。严格掌握手术适应证、术前细胞阅读CT片、熟悉鞍区解剖、熟练掌握经蝶手术技术会明显减少经蝶鞍内手术并发症。     

头颈外科

20021348经蝶窦鞍内手术严重和罕见并发症分析/刘海生…//中华耳鼻咽喉科杂志一2002,37(2)一124~126 目的:探讨经蝶窦鞍内手术发生严重与罕见并发症的原因和预防措施。方法:分析1962~2001年3月间200例经蝶窦鞍内手术,发生严重和罕见并发症的16例临床资料,探讨其发生原因与预防方法。结果:16例发生严重和罕见并发症(8%),其中死亡4例(2%),严重出血8例(4%),视力恶化2例(1%),精神障碍2例(1%),癫痛持续状态1例(0 .5%),剧烈头痛1例(0 .5%),脑组织损伤2例(1%)。结论:经蝶窦手术与经颅手术相比损伤明显减少,但仍可发生多种并发症。严格掌握手术适应…     

经蝶窦鞍内手术严重和罕见并发症分析

目的　探讨经蝶窦鞍内手术发生严重与罕见并发症的原因和预防措施。方法　分析196 2～ 2 0 0 1年 3月间 2 0 0例经蝶窦鞍内手术 ,发生严重和罕见并发症的 16例临床资料 ,探讨其发生原因与预防方法。结果　 16例发生严重和罕见并发症 (8% ) ,其中死亡 4例 (4% ) ,严重出血 8例 (4% ) ,视力恶化 2例 (1% ) ,精神障碍 2例 (1% ) ,癫痫持续状态 1例 (0 5 % ) ,剧烈头痛 1例 (0 5 % ) ,脑组织损伤 2例 (1% )。结论　经蝶窦手术与经颅手术相比损伤明显减少 ,但仍可发生多种并发症。严格掌握手术适应证、术前仔细阅读CT片、熟悉鞍区解剖、熟练掌握经蝶手术技术会明显减少经蝶窦鞍内手术并发症     

经蝶窦显微手术切除垂体腺瘤死亡3例分析

为总结经蝶窦显微手术切除垂体腺瘤术后出现严重手术并发症的经验教训，列举３个死亡病例，分析其临床特点及死亡原因。死亡原因主要为：吸引器伸入瘤腔过深突破肿瘤边界造成中脑直接损伤；瘤床出血通过破损的鞍隔及硬膜进入蛛网膜下腔引起脑血管痉挛。尽管经蝶窦显微手术切除垂体腺瘤与传统开颅手术相比有很多优点，但应严格掌握手术适应证的选择，提高手术技巧     

经蝶窦显微手术切除垂体腺瘤死亡3例分析

为总结经蝶窦显微手术切除垂体腺瘤术后出现严重手术并发症的经验教训，列举了３个死亡病例，分析其临床特点及死亡原因。死亡原因主要为：吸引器伸入瘤腔过深突破肿瘤边界造成中脑直接损伤；瘤未出血通过破损的鞍隔及硬膜进入蛛网膜下腔引起脑血管痉挛。尽管经蝶窦显微手术切除垂体腺瘤与传统开颅手术相比有很多优点，但应严格掌握手术适应证的选择，提高手术技巧。     

经蝶窦鞍区肿瘤切除术并发症原因分析及处理

总结经蝶窦鞍区肿瘤切除术的并发症发生原因,预防及治疗效果。方法：回顾分析１９８９年９月－１９９６年６月１１６例鞍区肿瘤经蝶手术的资料,其中垂体肿瘤１０７例,脊索瘤６例,颅咽管瘤３例。结论经蝶手术可发生各种并发症,应积极预防及正确处理,以降低其发生率。     

经蝶窦鞍区手术出现并发症的原因分析

报告于１６２例经蝶窦鞍区手术中发生的各类并发症３４例，对各种并发症发生的原因进行分析，并提出相应的预防及处理措施。     

头颈外科

890001 经鼻口蝶窦垂体肿瘤手术/赵伟…∥北京医科大学学报.-1988,20(1).-59～60 报道经蝶窦垂体瘤手术14例,其中10例采用鼻口蝶窦入路。介绍术中对鞍内及蝶窦的处理:3例无脑脊液漏者采用中隔带蒂粘膜瓣复盖,其余11例(包括6例有脑脊液漏者)采用筋膜、肌肉和脂肪充填。强调鼻腔正确充填的重要性,并对术后并发症进行了讨论。参4(原提要)     

经蝶窦鞍区手术的某些进展

本文就经蝶窦鞍区手术的历史和现状作简要综述,着重描述蝶窦和鞍区的显微解剖、经蝶手术的适应证及手术的优缺点,并对不同手术径路进行比较。最后对垂体肿瘤及垂体手术方法、术中应注意的问题及并发症的处理做简要说明。     

鼻内镜下经鼻腔-蝶窦入路切除垂体大腺瘤13例

目的：了解鼻内镜技术用于经蝶窦入路切除垂体大腺瘤的可行性。方法：对13例垂体大腺瘤患者采用鼻内镜下经鼻腔-蝶窦入路切除术式。结果：肿瘤全切除9例(69．2％)，大部切除3例(23．1％)，手术失败1例(7．7％)。术后1周内视力、视野明显改善10例(76．9％)，其中7例接近或完全恢复正常。除2例短暂脑脊液漏外，无其他严重并发症及死亡病例发生。结论：鼻内镜用于经鼻腔-蝶窦入路切除垂体大腺瘤可获得满意的临床效果，但应注意避免术中出血、解剖变异、鞍旁组织向鞍内膨出、复发性垂体大腺瘤及术后不适当的瘤腔处理对鼻内镜手术操作及疗效的影响。     

Assessment of post-operative healing following endoscopic,transnasal, transsphenoidal pituitary surgery without formal sellar grafting

IntroductionMultiple options exist for sellar reconstruction after endoscopic transnasal, transsphenoidal surgery (TSS) including free mucosa, fat, bone and synthetic materials. The objective of this study was to assess healing and mucosalization of the sellar face following TSS without formal sellar grafting or reconstruction.MethodsSingle institution retrospective chart review was conducted for patients undergoing TSS without intraoperative CSF leaks between January 2014 and March 2017 at Rush University Medical Center. No formal sellar reconstruction was performed for the entire patient group. Follow-up endoscopic data and clinical notes were coded for time to mucosalization of the sella as well as degree of abnormal mucosal healing, epistaxis, crusting and scarring.Results83 patients were included in this study. Mean time to mucosalization was 119 days (range, 17 to 402 days). Incidence of abnormal mucosal healing, epistaxis, crusting and scarring increased from the first to the second postoperative visit but trended down by the third visit. Nasal crusting was the most common finding, followed by abnormal mucosal healing. Chi square analysis showed smoking to be associated with prolonged time to full mucosalization of the sella. Two patients (2.4%) had post-operative CSF leaks requiring lumbar drain placement.ConclusionAdequate sellar healing is achievable in all cases without formal grafting or reconstruction after TSS. Great care must be exercised given the small inherent risk of unmasking a subclinical intraoperative CSF leak. Patients should be followed closely endoscopically during the first four months after TSS to minimize the impact of crusting.     

MRI对鞍区病变的诊断价值

目的 探讨MRI对鞍区病变的诊断价值。方法 分析70例经手术病理证实的鞍区病变的MRI征象，结果 垂体腺瘤37例，动脉瘤190例颅咽管瘤12例，鞍区脑膜瘤9例，鞍区星形细胞瘤2例。结论 MRI能正常显示鞍区病变的部位、形态、大小、范围及周围结构的受累情况。对鞍区病变的诊断具有重要意义。     

蝶窦鞍区非垂体源性占位病变的诊断

目的 提高蝶窦鞍区非垂体源性占位性病变的诊断水平。方法 总结分析２４例蝶窦鞍区非垂体源性占位性病变，其中良好１８例，包括蝶窦囊肿７例、颅咽管瘤６例、脊索瘤２例，鼻息肉伴鼻结杆菌感染侵犯蝶窦鞍区、蝶鞍神经鞘瘤、鞍内异位松果体瘤各１例。恶性肿瘤６例，分别为蝶窦神经内分泌肿瘤２例，腺样囊腺癌１例，蝶窦低分化癌１例，鼻咽癌侵犯区肺癌蝶窦转移各１例。从临床表现、体征、曩像学检查及诊断治疗上进行了分析、讨论。     

蝶鞍区颅咽管瘤侵犯鼻窦鼻咽部2例报告(附文献复习)

目的 探讨侵犯鼻窦、鼻咽部的蝶鞍区颅咽管瘤的发病原因、临床表现和治疗方法。方法 对北京协和医院1983～2001年间诊治的2例侵犯鼻窦、鼻咽都的蝶鞍区颅咽管瘤进行回顾性研究，并复习关于累及鼻窦、鼻咽部的颅咽管瘤的文献报道。结果 2例累及鼻窦、鼻咽部的颅咽管瘤，1例为鞍内肿瘤向下侵犯，1例源于蝶鞍底。手术治疗加放疗或根治性切除取得满意的效果。结论 累及鼻窦、鼻咽部的颅咽管瘤可源于蝶鞍或蝶鞍上区的肿瘤向下侵犯，也可源于蝶鞍区以下的颅咽管残迹或咽垂体，主要症状包括：鼻塞、头痛、视力下降。治疗可采用根治性切除或次全切除加放疗。     

Endoscopic transsphenoidal approach versus microscopic approach in children

Objectives

To confirm the efficacy and safeness of the endoscopic endonasal transsphenoidal (ETS) approach in the treatment of sellar and parasellar lesions in children compared with the conventional microscopic transsphenoidal approach (CTS).

Study design

Case series with chart review.

Setting

A. Gemelli - University Hospital - Catholic University of Sacred Heart - Rome.

Subject and methods

We retrospectively evaluate 21 children (mean age 8.3 years) affected by sellar/parasellar lesions: 11 were treated via microscopic sublabial approach between 1995 and 2005 and 10 were treated with ETS approach between 2006 and 2009.

Results

The past series (group A) comprised all sellar/suprasellar lesions and we observed: gross total surgical excision in 81.2% of cases, permanent morbidity in 1/11 patients, CSF fistula in 1/11 patients, mean hospitalization time of 5.8 days and PICU was required. The present series (group B) included 8 sellar/suprasellar and 2 clival lesions and we observed: GTS excision in 80% of the cases, no permanent morbidity, a mean hospitalization time of 4.1 days (P = 0.01), CSF fistula in 2/10 patients and the PICU was not required. 10/11 patient of group A underwent to blood transfusion vs 4/10 of the group B (P = 0.008). The mean pain score of group A was 5.8 ± 1.7 on the contrary in the group B it was 4.1 ± 1.5 (P = 0.006).

Conclusion

The ETS approach to the sellar and parasellar region has proved its reliability and effectiveness in the adults. The minimal invasiveness makes it ideal for the treatment of pediatric lesion of this region, in which it is essential to preserve the integrity of the hypothalamic-pituitary axis and of the naso-facial structures to assure the correct growth of the child.     

内镜下单鼻孔蝶窦入路切除鞍内病变

目的总结内镜下经单鼻孔蝶窦入路切除鞍内病变的疗效与手术经验。方法回顾性分析136例鞍区病变患者的临床资料及手术方法,其中垂体腺瘤116例,Rathke囊肿16例,颅咽管瘤4例,均采用神经内镜下经单鼻孔蝶窦入路鞍内切除病变。结果垂体腺瘤116例,肿瘤全切90例（77．6％）,次全切26例（22．4％）;Rathke囊肿16例,均全切16例（100％）;颅咽管瘤4例,全切1例（25％）,次切3例（75％）。术后视力及视野改善83例,内分泌指标恢复正常95例。脑脊液鼻漏7例,2周后自愈;一过性尿崩25例。本组无死亡病例,无颅内出血等其他并发症。结论神经内镜下经单鼻孔蝶窦入路手术切除鞍内病变具有安全、视野清晰、术时短、肿瘤切除更为彻底及术后并发症少等优点,是较理想的经蝶手术术式。     

内窥镜下蝶窦和蝶鞍手术

目的 探讨内窥镜下蝶窦和蝶鞍区手术的体会。方法 内窥镜下治疗脑脊液蝶窦漏１例，蝶窦金属（子弹）异物３例，蝶窦囊肿５例，蝶窦霉菌病５例，蝶窦息肉１例，蝶筛窦腺癌１例；垂体腺瘤２３例（微腺瘤１７例，侵袭性腺瘤６例），颅咽管瘤２例。结果 蝶窦囊肿、息肉和霉菌病治愈；垂体微腺瘤和１例颅咽管瘤全切术；侵袭性腺瘤、１例颅咽管瘤和蝶筛窦腺癌部分切除，死亡１例（垂体腺瘤术中出血）；脑脊液鼻漏治愈；蝶窦异物２例取出     

Trans-septal endoscopic approach of pituitary tumors

The advances in endoscopic instruments have eased the approach to the sellar region through the nasal cavity. We carry out an analysis of the surgical results on 20 patients that underwent surgery for sellar tumours through a transeptal-transphenoidal approach in the last 2 years in our hospital. The average was 45.6 years old, and 75% were females. 30% of cases were pituitary adenomas and another 30% acromegaly, 25% Cushing's disease and 10% prolactinomas. No complications were encountered during surgery being the most common postoperative complications, diabetes insipida in two cases (10%) and CSF leak in one case. At present 2 patients are having hormonal treatment for panhypopituitarism. No patients developed a septal perforation, nasal deformity, epistaxis, meningitis, lip numbness or oronasal fistula. The rest did have good results noith no recurrence and hormonal values back to normal.     

Endoscopic endonasal transsphenoidal surgery for sellar tumors in children

Objective

Endoscopic endonasal transsphenoidal surgery (EETS) is still rarely used in pediatric subjects compared with adults. Reports on EETS in children appeared only recently in the literature, usually regarding small series. The aim of the study is to assess the actual role and the limits of EETS in children with sellar tumors by reporting a two-centers experience.

Methods

Twenty-seven children (mean age: 12.2 years) were operated on during the last decade. Seventeen patients harbored a sellar mass, 7 a suprasellar tumor, and 3 a clival mass. Laboratory investigations revealed hypopituitarism in 6 children and hormone hypersecretion in 9. All the operations were carried out by a team including both ENT surgeon and neurosurgeon using a dedicated 18-cm long rigid endoscope (2.7 mm and 4 mm diameter) through the direct paraseptal or the transethmoidal or the transpterygoid route.

Results

Overall, 29 operations were performed. Gross total tumor resection was obtained in 22 children (81.5%) while a subtotal and a partial removal in 2 (7.5%) and 3 cases (11%), respectively. Pituitary adenoma was the most common histotype (12 cases), followed by craniopharyngioma (5) and Rathke's cleft cyst (4). No surgical mortality or neurological morbidity or late nasal complications were observed. Postoperative CSF fistula occurred in 3 patients. All children are alive at current follow-up (average: 8.6 years). Preoperative hypopituitarism disappeared or improved in 4 cases and was stable in the remaining 2 (no new hormone deficits appeared).

Conclusion

EETS is a safe and effective surgical option also in children. As for adults, it allows to manage most of the tumor lesions of the sellar region with stable long-term results.     

Resection of extensive sellar tumors with extended endoscopic transseptal transsphenoidal approach

The endoscope has recently been used to extensive sellar lesions, but the extended areas of the lesions and operative techniques vary from each study. Here we present our experience with extended endoscopic transseptal transsphenoidal (EETT) approach to 16 patients with extensive sellar lesion and evaluate the feasibility of EETT in different extensive sellar tumor resection. Sixteen patients with extensive sellar lesion were operated by EETT approach in this study. The approach included unilateral posterior septum mucosa resection, posterior septectomy, extended ethmoidectomy and sphenoidoctomy, four tumoral circumferences (bilateral, superior, inferior aspects) isolated and subsequently tumoral removal from outside to inside of the tumors obtained. This surgical procedure is satisfactory for sellar lesion with different juxtasellar extension. After surgery, CT scan and MR image showed that total removal of the tumor was achieved in 10 patients. Six patients who received subtotal resection were treated with postoperative radiation therapy or gamma knife surgery. Two patients developed postoperative cerebrospinal fluid leak that was successfully managed by conservative treatment within 6 days after surgery. No other new postoperative endocrinological or neurological defects occurred. Six months to 5 years follow up indicated that all 16 patients with the visual disturbances and 4 patients with endocrine impairments have recovered or improved. One patient with malignant meningioma died due to recurrence of the tumor 2 years postoperation. Another one patient with malignant inverted papilloma recurred 1 year postoperation and underwent operation and radiation therapy again. The EETT approach might better facilitate the removal of different extensive sellar lesions with maximal preservation of important anatomical structures and nasal function.