神经内镜下经单鼻孔-蝶窦摘除垂体腺瘤(附127例报告)

目的总结神经内镜下经单鼻孔-蝶窦路径摘除大型垂体腺瘤(LPA)的手术技术,并评价其疗效.方法回顾性分析127例LPA经蝶内镜手术经验.术前影像学检查示肿瘤均压迫视神经与视交叉.结果肿瘤全切除114例(89.8%),次全切除9例(7.1%),4例(3.1%)纤维性肿瘤仅获部分切除.术后死亡1例.110例获得平均3个月的随访,视力迅速恢复101例(91.8%),余9例(8.2%)好转;术前视野缺损107例,术后100例(93.5%)恢复,另7例(6.5%)改善.结论神经内镜下经单鼻孔-蝶窦路径切除LPA是一种有效的微侵袭手术方法.     

神经导航辅助下经单鼻孔蝶窦入路显微手术切除垂体腺瘤 (附26例临床报告)

目的探讨神经导航辅助下经单鼻孔蝶窦入路显微手术切除垂体腺瘤的初步体会、注意事项及该手术入路优缺点。方法对26例垂体腺瘤患者采用神经导航辅助下经单鼻孔蝶窦入路显微手术治疗。结果术后经MRI检查证实全切除20例,4例次全切除,2例巨大腺瘤大部切除,术后均未出现严重并发症。结论神经导航辅助下经单鼻孔蝶窦入路显微手术切除垂体腺瘤,手术快捷、安全、创伤小,符合微创治疗趋势。     

经单鼻孔-蝶窦入路显微手术切除垂体腺瘤25例分析

目的 总结经单鼻孔-蝶窦入路显微手术切除垂体腺瘤的治疗经验.方法 对25例垂体腺瘤病人采用经单鼻孔-蝶窦入路显微手术切除.结果 全切除20例,大部分切除5例.病人视力、视野及内分泌功能术后均有改善,出现尿崩症19例,1例术后出现蛛网膜下腔出血,经治疗均治愈.结论 经单鼻孔-蝶窦入路切除垂体腺瘤具有创伤小、手术时间短、恢复快、简便、安全、有效等优点,术中准确、轻柔的操作是预防术后并发症的关键.     

垂体腺瘤经单鼻孔内镜下切除

目的 总结我科经单鼻孔蝶窦入路内窥镜下切除垂体腺瘤32例的手术经验。方法 经CT或MRI诊为垂体腺瘤的32例患者，应用电视监测内窥镜经单鼻孔进入，术中不切除鼻中隔，直接打开蝶窦前壁，经鞍底切除垂体腺瘤。结果 全切除26例，近全切除6例。视力、视野均较术前有所恢复。2例术后出现一过性脑脊液鼻漏，2例发生暂时性尿崩：术后9例内分泌检查恢复正常，5例随访激素水平下降。结论 经蝶窦入路内窥镜下切除垂体腺瘤，具有手术时间短，创伤小，安全且并发症少等优点，值得推广。     

巨大型垂体腺瘤51例报告

目的 总结经单鼻孔-蝶窦入路和经额下入路显微手术治疗巨大型垂体腺瘤的临床经验.方法 显微手术治疗巨大型垂体腺瘤51例,其中经单鼻孔-蝶窦入路手术13例,经额下入路手术38例.结果 经单鼻孔-蝶窦入路显微手术全切7例,大部切除4例,部分切除2例;经额下入路显微手术全切18例,大部切除13例,部分切除4例,死亡3例.两种手术方法的疗效无明显差别.结论 经单鼻孔-蝶窦入路和经额下入路显微手术都是治疗巨大型垂体腺瘤的有效方法,术后正确选用溴隐亭和伽玛刀治疗可提高巨大型垂体腺瘤的治愈率.     

经单鼻孔蝶窦入路内窥镜下切除垂体腺瘤26例

目的观察经单鼻孔蝶窦入路内窥镜下切除垂体腺瘤的效果。方法在内窥镜良好的照明、图像放大及清晰的术野下经单鼻孔蝶窦入路切除垂体腺瘤26例。结果手术后随访6个月至2年,复发2例,其余24例临床症状减轻或消失,效果较满意。结论经单鼻孔蝶窦入路内窥镜下切除垂体腺瘤能准确判断重要解剖结构、损伤小、方法简便、容易取得成功。     

神经内窥镜在垂体腺瘤切除术中的应用

目的探讨神经内窥镜技术在垂体腺瘤切除术中的应用方式及特点。方法在32例垂体腺瘤切除术中使用了神经内窥镜。其中15例采用内镜辅助下眶上“锁孔”入路垂体腺瘤显微切除术,17例采用神经内镜控制下经单鼻孔-蝶窦入路垂体腺瘤切除术。结果本组32例术后无1例死亡,无1例出现颅内出血、视神经损伤、颈内动脉损伤及脑脊液鼻漏等现象。用内镜控制的经单鼻孔-蝶窦入路垂体腺瘤切除术的17例病例中,15例肿瘤全切,1例肿瘤近全切除,1例肿瘤大部分切除。用内镜辅助的经眉切口眶上“锁孔”入路垂体腺瘤显微切除术的15例病例中,14例肿瘤全切,1例肿瘤近全切除。2例病人术后出现一过性多尿。本组32例患者术后随访3～15个月,原有症状均有所改善,异常增高的激素水平均降至正常,MRI检查显示无1例肿瘤复发。结论内镜辅助下经眉切口眶上“锁孔”入路垂体腺瘤显微切除术和内镜控制下经单鼻孔-蝶窦入路垂体腺瘤切除术符合微创原则,术后并发症少,疗效满意。提倡在垂体腺瘤切除术中使用神经内窥镜技术。     

经单鼻孔蝶窦内镜辅助显微手术切除垂体腺瘤

目的总结经单鼻孔蝶窦入路内镜辅助显微手术治疗垂体腺瘤的初步体会,探讨其技术优势、评价其疗效。方法回顾性分析2000～2006年间经单鼻孔蝶窦入路内镜辅助显微手术治疗的40例垂体腺瘤的临床资料。结果本组40例垂体腺瘤患者,36例全切除,4例次全切除。患者术后症状均改善,视野缺损(偏盲)在术后1周内基本恢复,视力减退、泌乳等症状有明显改善。术后并发症为暂时性尿崩症15例,多于术后2周内停止;脑脊液漏2例,经保守治疗痊愈;无颅内感染、无鼻中隔穿孔等并发症;1例于术后3年复发,再次经单鼻孔蝶窦显微手术次全切除(肿瘤已侵袭海绵窦),术后辅以放疗。结论内镜辅助的直接经单鼻孔蝶窦显微手术是治疗垂体腺瘤的一种安全、微创、有效的方法。     

经单鼻孔-蝶窦入路显微手术切除垂体腺瘤(附32例分析)

目的总结经单鼻孔-蝶窦入路切除垂体腺瘤的治疗经验。方法对32例病人采用经单鼻孔-蝶窦入路进行垂体腺瘤切除术，其中微腺瘤2例，大腺瘤22例，巨大腺瘤8例；伴垂体卒中3例。结果20例全切除，10例次全切除，2例大部切除临床症状术后均有改善。术后出现短期尿崩18例，脑脊液鼻漏1例，垂体功能低下2例；经治疗后均缓解。结论经单鼻孔-蝶窦入路切除垂体腺瘤具有创伤小、恢复快、简便、安全、有效等优点；术中准确、轻柔的操作是预防术后并发症的关键。     

经单鼻孔蝶窦入路显微手术切除大型垂体腺瘤

目的探讨经单鼻孔蝶窦入路手术切除大型垂体腺瘤(最大径>3cm)的效果及其手术技巧。方法回顾性分析经单鼻孔蝶窦入路手术切除的43例大型垂体腺瘤患者的临床资料。结果肿瘤全切除31例,次全切除8例,大部分切除4例。术后1周视力下降、视野缺损改善36例。术后出现一过性尿崩症11例,脑脊液鼻漏2例,迟发性鼻腔出血1例。本组无死亡病例。术后42例随访3月～2年,视力下降、视野缺损均有不同程度改善,头部MRI示肿瘤无残留29例,部分残留13例。结论经单鼻孔蝶窦入路手术可有效切除大型垂体腺瘤,但需熟练掌握手术技巧,减少肿瘤残留。     

经单鼻孔-蝶窦入路内镜下切除侵袭性垂体腺瘤

目的：总结采用经单鼻孔-蝶窦入路、神经内镜下切除侵袭性垂体腺瘤（IPA）的手术经验,探讨适应证选择、技术要点及临床应用前景。方法：82例IPA中,37例（45.1%）为功能性、45例（54.9%）系非功能性肿瘤。均采用内分泌学检查及CT或MRI进行诊断,经单鼻孔-蝶窦入路、神经内镜下切除肿瘤。结果：肿瘤全切除65例（79.2%）,次全切除13例（15.9%）,部分切除（为纤维性或哑铃型肿瘤）4例（4.9%）。69例术后随访期平均42.1个月,其临床症状均有不同程度改善。其中54例术前有明显视器压迫障碍、且肿瘤获全切除者,96.3%（52例）视力、视野均有显著好转。结论：神经内镜下经单鼻孔-蝶窦入路手术切除IPA,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,是神经外科领域切除IPA的一项很有前途的技术方法。     

Endoscopic endonasal transsphenoidal surgery for invasive pituitary adenoma.

Invasive pituitary adenomas (IPA) involving the skull base extend from the sella region, and invade surrounding structures. In the present study, we reviewed the therapeutic efficacy in a group of patients with IPA treated with endoscopic endonasal transsphenoidal surgery. Data from 78 IPA patients at our hospital were retrospectively reviewed. The diagnostic modalities, surgical techniques, and outcomes were reviewed. Diagnosis was confirmed by endocrinological profile and CT or MRI in all patients. Surgery was performed via an endoscopic endonasal transsphenoidal approach. Thirty-five patients (44.9%) had hormonally active tumors, and 43 (55.1%) had nonfunctioning tumors. Complete removal of the tumor was achieved in 62 patients (79.5%) and subtotal removal in 12 (15.4%); partial removal was achieved in the remaining four patients (5.1%) who had fibrous or dumbbell-shaped adenomas. The mean follow-up was 43.2 months in 65 patients and the clinical symptoms in all patients improved to varying degrees. In 52 patients, the tumors completely disappeared on follow-up imaging. Visual symptoms improved in 96.4% of the patients who had presented with visual impairment. These surgical results show that endoscopic endonasal transsphenoidal surgery for resection of IPA has advantages. We suggest that the endoscopic endonasal transsphenoidal surgery method is a safe, minimally invasive and efficient surgical technique for removal of IPA, providing good visualization of the operative field, generally complete tumor removal, short procedure duration, and minimal postoperative complications.     

神经内镜下经单鼻孔蝶窦垂体腺瘤切除术

目的探讨神经内镜下经单鼻孔蝶窦切除垂体腺瘤的技术方法和疗效。方法 2006年8月至2009年5月在神经内镜下经单鼻孔蝶窦切除垂体腺瘤202例。结果肿瘤全切除171例(84.65%),次全切除22例(10.89%),部分切除9例(4.46%),术后临床症状改善196例(97.02%)。术后血清内分泌激素较术前有所改善173例(85.64%)。28例(13.86%)出现术后并发症,包括尿崩症、鼻腔出血和脑脊液漏。结论神经内镜下经单鼻孔蝶窦垂体腺瘤切除术具有手术创伤小、术后并发症少等优点,是一种安全、有效的治疗方法。     

内镜下扩大经鼻蝶入路术中多层技术颅底重建

目的总结内镜下扩大经鼻蝶入路鞍区及鞍旁区多层技术重建颅底的经验。方法回顾性分析12例鞍区及鞍旁区肿瘤的临床资料,其中颅咽管瘤4例,鞍区脑膜瘤3例,巨大垂体腺瘤5例;均行内镜下扩大经鼻蝶入路肿瘤切除术,并采用多层技术进行颅底重建。结果所有病例肿瘤均达全切除,颅底重建均1次修补成功。术后部分临床症状明显改善。随访3～6个月,均未出现脑脊液漏、细菌性脑膜炎和张力性气颅等并发症。结论内镜下扩大经鼻蝶入路术中多层技术重建颅底是一种简单、安全、有效的方法。     

神经内镜下经鼻-扩大蝶窦入路术后颅底重建(附20例分析)

目的探讨神经内镜下经鼻-扩大蝶窦入路术后的颅底重建技术。方法回顾性分析20例神经内镜下经鼻-扩大蝶窦入路术后的颅底重建经验。其中鞍结节脑膜瘤7例,颅咽管瘤3例,垂体腺瘤10例。在切除肿瘤后均采用人工硬脑膜-明胶海绵和生物胶-人工硬脑膜的"三明治"式方法,同时辅以球囊支持修补材料和持续腰池引流。结果1次手术修补成功15例,短暂性脑脊液鼻漏经保守治疗治愈3例,2例2次内镜下经鼻入路行颅底重建得以修复。术后随访6个月～4年,疗效满意。结论"三明治"式修补方法加球囊支撑和持续性腰池引流,可显著降低术后脑脊液鼻漏的发生,是神经内镜下经鼻-扩大蝶窦入路术后颅底重建的可靠技术。     

Endoscopic endonasal pituitary surgery: surgical and outcome analysis of 50 cases.

OBJECTIVE: Microsurgical transsphenoidal surgery for pituitary tumors has been standard therapy for decades and was established by Harvey Cushing in the early twentieth century. Today, endoscopy is increasingly accepted in the therapy of pituitary lesions. In this retrospective study, we analysed the surgical technique and outcome of 50 patients with pituitary lesions treated with an endoscopic endonasal trans-sphenoidal approach. METHODS: Between January 2004 and July 2005, 50 patients (30 female and 20 male) with pituitary tumors were operated upon using an endoscopic endonasal trans-sphenoidal procedure without nasal speculum or postoperative nasal packing. The follow-up period ranged from 3 to 18 months. RESULTS: All patients had normal airways through both nostrils immediately after extubation. Postoperative discomfort was minimal and hospitalization was 4-5 days. Three patients developed postoperative transient diabetes insipidus, persisting in one for a further 2 months. Among the 50 patients, total tumor removal was achieved in 47 patients (94%), subtotal in two patients (4%). One patient died intraoperatively due to subarachnoid haemorrhage. CONCLUSION: The endoscopic endonasal transsphenoidal approach for removing pituitary lesions is a form of minimally invasive surgery offering excellent postoperative results.     

Preservation of hormonal function by identifying pituitary gland at endoscopic surgery

ObjectiveThe endonasal endoscopic approach has been established for perisellar tumor surgery with a higher resection rate and reduced complications. We analyzed the potential to identify the pituitary gland under endoscopic view, at surgery and see its relation to postoperative hormonal insufficiency in endonasal endoscopic procedures.MethodsBetween January 2011 and January 2014, 70 cases of pituitary adenomas with preoperative intact pituitary function underwent endoscopic endonasal transsphenoidal procedures for intrasellar pathologies. Endocrinologists and neurosurgeons followed these patients prospectively. Special attention was paid to intraoperative identification of gland tissue, surgical complications, degree of resection and postoperative hormonal insufficiency.ResultsThe pituitary gland was identified in 57 out of 70 procedures (81.4%). Eleven percent (8 of 70 patients) had persistent pituitary insufficiency. Two of these 8 patients belonged to the group with pituitary gland identification (2 out of 57); thus, when the pituitary gland was identified during the procedure postoperative hormonal insufficiency was seen in 3.5% of cases. Failure of pituitary gland identification presented with hormonal insufficiency of 46.2%. In analysis with Fisher’s exact test, there was a high significant correlation between the identification of the pituitary gland intraoperatively and normal pituitary function postoperatively (p < 0.005). On follow up radical tumor resection was seen in 88% (62 of 70 patients).ConclusionsThis study indicates that identification and preservation of pituitary gland tissue and function is possible in endoscopic transsphenoidal surgery. This preservation of gland tissue is a positive predictor of postoperative normal pituitary function.     

经单鼻孔蝶窦入路神经内镜下切除垂体腺瘤

目的 探讨神经内镜在经鼻蝶入路手术切除垂体腺瘤术中的应用价值和术中注意事项。方法 回顾性分析221 例垂体腺瘤手术病例的临床资料。手采用经单侧鼻孔蝶窦入路内镜下切除肿瘤,必要时在导航确认下进行。术后3个月复查头颅增强MRI判断肿瘤切除情况。结果 术中无定位错误病例,无大的血管和神经损伤病例。肿瘤全切除178例,次全切除37例,大部切除6例。术后死亡3例。术后无永久性尿崩和脑脊液漏病例,2例围手术期鼻腔大出血,治疗后好转。术前视力和视野障碍病人术后无恶化。结论 内镜结合导航经鼻蝶入路切除垂体腺瘤创伤小,导航可增加手术安全性和扩大手术适应症;充分的术前准备和规范的术中操作是预防术后并发症、提高手术疗效的关键。     

经鼻蝶窦入路神经内镜辅助手术治疗鞍区病变(附26例报告)

目的探讨经鼻腔蝶窦入路神经内镜辅助手术的方法。方法全麻下经单鼻腔蝶窦导入神经内镜行26例鞍区病变切除，必要时辅以显微镜。结果24例肿瘤病人中20例全切除，4例次全切除。术后无一例发生脑脊液漏和颅内感染。1例垂体脓肿和1例空蝶鞍均临床治愈。随访6-25个月，10例视力恢复至5．0，6例月经恢复正常，11例内分泌水平恢复正常。结论经鼻腔蝶窦入路神经