垂体腺瘤经颅手术的显微解剖及临床应用

目的探讨一种可一次全切巨大型侵袭性垂体腺瘤的手术入路，并在临床上应用以验证其实际意义。方法采用15例经福尔马林固定的国人成人头颅湿标本共30侧，模拟额颞眶颧手术人路并逐步对相关的解剖标志进行详细地显微解剖。结合该区域的显微解剖，笔者回顾性总结了近几年收治的采用额颞眶颧入路治疗5例巨大型侵袭性垂体腺瘤的临床资料。结果在硬膜下阶段，根据垂体腺瘤生长的不同方向，可从多个间隙切除肿瘤。联合经硬膜外的海绵窦外侧壁入路可达到一次全切巨大型侵袭性垂体腺瘤的目的。5例巨大型侵袭性垂体腺瘤中，3例全切除，1例为次全切除，1例大部分切除。结论巨大型侵袭性垂体腺瘤可采用额颞眶颧入路进行手术治疗，根据需要可对该人路进行适当裁剪。

Microsurgical anatomy and clinical application of transcranial surgery for pituitary adenomas

Objective To explore an approach for once for all removal of giant invasive pituitary adenomas, and to verify practical significance of the approach. Methods Using standard microsurgical equipment and instruments, the authors performed 30 frontotemporal-orbitozygomatic （EFOZ） approaches in 15 embalmed cadaver heads in which the vascular systems had been injected with colored material. 5 cases used the EFOZ approach were retrospectively reviewed. Results During intradural phase, depending on the direction of extension of the pituitary adenoma, tumor can be removed through multiple access corridors and be achieved by the approach combining epidural lateral wall of cavernous sinus. In 5 cases of giant invasive pituitary adenoma, 3 total removal, 1 subtotal removal, and 1 partially subtotal removal. Conclusion FTOZ approach could be used to treat the giant invasive pituitary adenoma and the approach should be tailored according to the requires.