神经导航与内镜辅助下经鼻蝶切除垂体腺瘤

目的探讨神经导航系统与内镜相结合在单鼻孔经蝶入路垂体腺瘤切除术中的应用及其优越性。方法在神经导航系统与内镜辅助下对32例垂体腺瘤患者实施经鼻蝶手术。术前将患者影像信息导入神经导航系统进行解剖三维重建，术中对手术入路．周围重要解剖结构及肿瘤准确定位。结果本组32例患者中，肿瘤全切26例，次全切除6例，无手术死亡病例。术后12例头痛消失，18例视力、视野缺损改善，5例出现一过性尿崩症，2例发生脑脊液鼻漏。结论神经导航系统与内镜的联合应用，在经鼻蝶垂体腺瘤手术中能准确定位肿瘤与周围重要解剖结构，并引导手术操作，可安全、准确地切除肿瘤，提高手术疗效。

Neuronavigator- and Endoscope-assisted Microsurgery through Endonasal Transsphenoidal Approach for Pituitary Adenomas

Objectives To study the application of neuronavigator- and endoscope-assisted microsurgery through endonasal transsphenoidal approach to the resection of pituitary adenomas. Methods Neuronavigator- and endoscope-assisted microsurgery through endonasal transsphenoidal approach were performed in 32 patients with pituitary adenomas. The imaging informations of the pituitary adenoma and important structures around them were infused into the neuronavigation system, by which their three- dimensional images were reconstructed before the operation in all the patients with pituitary adenomas. The operative approach, the tumors and important structures around the tumors were accurately localized and the extents of resecting the tumors were estimated by the neuronavigation system and endoscope during the operation. Results Of 32 patients with pituitary adenomas, 26 received total resection of the tumors and 6 subtotal. The headache disappeared in 12 patients, and the visual field and power were improved in 18 patients after the operation. The major complications induced diabetes insipidus in 5 cases and cerebrospinal fluid rhinorrhea in 2 cases. The postdperative bleeding, deterioration in visual power and field, intracranial infection did not occurred in all the patients. No patients died from the operation. Conclusions The application of neuronavigation system- and endoscope- assisted microsurgery through endonasal transsphenoidal approach to pituitary adenomas is helpful to accurate localizations of the tumors and structures around the sellar area, safe and exact removal of the tumors, and enhancement of the curative effect.