伴甲介型、鞍前型蝶窦的垂体腺瘤经蝶入路手术治疗研究

目的 探讨伴甲介型、鞍前型蝶窦的垂体腺瘤经蝶人路手术治疗的方法及特点.方法回顾性分析中山大学附属三院神经外科自2004年6月至2009年6月收治的32例经蝶入路手术治疗的伴甲介型、鞍前型蝶窦的垂体腺瘤患者的临床资料,其中伴甲介型蝶窦的垂体腺瘤5例,伴鞍前型蝶窦的垂体腺瘤27例.根据术前CT多平面重建、CT仿真内镜及MRI影像资料,指导术中暴露鞍底,切除肿瘤.结果 未使用定位设备的情况下,术中均能顺利暴露鞍底,切除肿瘤,平均手术时间86min.术后3 d内MRI复查示肿瘤全切除25例,次全切除6例,大部分切除1例.结论 对于伴甲介型、鞍前型蝶窦的垂体腺瘤经蝶入路手术治疗,通过术前详细的影像学检查、术中磨钻及显微镜或内镜的使用,术中能准确辨认及充分暴露鞍底、切除肿瘤.

Transsphenoidal resection of pituitary adenoma accompanied by conchal or pre-sellar sphenoid sinus

Objective To investigate the method and characteristics of transsphenoidal resection of pituitary adenoma accompanied by conchal or pre-sellar sphenoid sinus. Methods The clinical data of 32 cases of pituitary adenoma accompanied by conchal or pre-sellar sphenoid sinus treated by transsphenoidal surgery between June 2004 and June 2009 were retrospectively analyzed. Preoperative CT multiplanar reconstruction, CT virtual endoscopy and MRI were performed to study the detail anatomic informations of sphenoid sinus and adenoma, and to guide the intraoperative seller floor exploration and tumor resection. Five patients with conchal sphenoid sinus and 27 with presellar sphenoid sinus were confirmed by preoperative image data. Results The seller floor exploration and tumor resection could be accomplished successfully with microdrill, microscope or endoscope, and the average operating time was about 86 minutes. Postoperative MRI within 3 d indicated that total resection, subtotal resection and resection of bulk were achieved in 25, 6 and 1 patient, respectively, and no serious complications occurred. Conclusion Pituitary adenoma accompanied by conchal and presellar sphenoid sinus can be surgically treated by transsphenoidal approach with the detailed preoperative CT and MR imaging and intraoperative use of microdrill, microscope or endoscope.