垂体瘤患者鼻蝶区内腔结构的影像学测量

目的 用计算机多平面重建方法（MPR）测量鼻蝶入路各结构的解剖学数据,为内镜下经蝶窦手术提供形态学参数依据.方法 60例垂体瘤患者行128层螺旋CT扫描,在MPR形成的冠状、矢状和横断面测量鼻蝶手术入路中蝶窦、鼻腔、蝶鞍等相关结构的形态学参数.结果 蝶窦窦腔的上下径为（26.40±4.80）mm,前后径为（25.90±6.00）mm,左右径为（37.30±7.00） mm.鼻小柱根部到蝶窦口下极的距离为（69.87±5.23）mm,鼻小柱根部到蝶窦最大横径与蝶窦侧壁交点的距离为（76.30±5.14）mm.鼻底平面与鼻小柱根部到蝶窦口下极连线的仰角为31.07°±6.40°,正中矢状面与鼻小柱根部到蝶窦最大横径与外侧壁交点的夹角为17.62°±2.99°.鼻前孔到鞍底中点的距离为（71.25±2.85）mm,蝶窦口到鞍底中点的距离为（13.15±1.68） mm.结论 获得鼻蝶入路相关结构的形态学参数资料,有助于指导经蝶窦顺利切除垂体瘤手术操作.     

老年侵袭性垂体瘤分子水平研究进展

老年侵袭性垂体瘤为良性肿瘤,却呈现恶性生物学行为,可以侵袭周围的硬膜、骨质或侵入海绵窦、蝶窦等结构,瘤体侵入海绵窦内并超过颈内动脉床突上段和海绵窦段中线连线水平被认为是侵袭性诊断的较为明确的指标。侵袭性垂体腺瘤具有高增殖、高侵袭、易复发、临床治愈率低、预后不佳的特点。     

神经导航单鼻腔蝶窦入路垂体腺瘤手术患者鞍区解剖结构的测量

目的神经导航测量单鼻腔蝶窦入路垂体腺瘤手术患者鞍区的解剖结构。方法对26例垂体腺瘤患者术前强化CT扫描图像进行三维重建,从不同角度和层面观察蝶窦和蝶鞍的结构;经单鼻腔蝶窦入路手术中,利用Brain LAB Vector Vision神经导航系统对相关解剖结构进行测量。结果经测量,蝶窦前后径为(22.1±6.5)mm、左右径为(17.6±6.1)mm、上下径为(19.0±5.8)mm,两侧海绵窦之间最小距离为(12.7±1.5)mm,两侧颈内动脉之间最小距离为(13.8±1.9)mm,左侧鼻孔中心到蝶窦腹侧壁的最短距离为(72.8±5.9)mm,左侧鼻孔中心到鞍底的最短距离为(82.2±6.3)mm。结论利用神经导航系统可以较准确地测量垂体腺瘤患者鞍区的解剖数据,这些数据对单鼻腔蝶窦入路手术有一定指导作用。     

经蝶手术治疗大型及巨型垂体腺瘤140例临床观察

目的观察经蝶手术治疗大型、巨型垂体腺瘤的临床疗效。方法大型、巨型垂体腺瘤患者140例。采用（左）鼻中隔切口,切开鼻前庭小柱,经鼻中隔—蝶窦中线处凿开鞍底,切除肿瘤。结果 140例肿瘤行包膜内全切除48例,其余行次全切除或大部分切除。术后症状立即改善者122例,并发暂时性尿崩症20例、脑脊液（CSF）鼻漏18例、颅内感染5例、垂体功能低下1例。结论对于大型和巨型垂体腺瘤,经蝶手术治疗可获良好效果。     

碘仿纱条蝶窦填塞治疗垂体腺瘤术中脑脊液漏疗效观察

目的观察碘仿纱条蝶窦填塞治疗经蝶窦入路垂体腺瘤切除术中脑脊液漏的疗效。方法采用鞍内填塞明胶海绵、鞍底应用人工硬膜贴附、碘仿纱布条填塞蝶窦的方法治疗垂体腺瘤切除术中脑脊液漏患者12例。结果患者本组患者术后自主活动,未平卧,未出现脑脊液鼻漏,无颅内感染及其他并发症发生。结论碘仿纱条蝶窦填塞治疗经蝶窦入路垂体腺瘤切除术中脑脊液漏疗效满意。     

经纵裂胼胝前切除巨大垂体腺瘤的显微应用解剖学研究

对 17个用甲醛固定、红色明胶动脉灌注的尸头标本采用显微解剖技术 ,观察其蝶鞍区的有关神经和血管。结果 :1视交叉前间隙的面积为 2 8.38± 6 .2 2 mm2 ,视交叉前缘至鞍结节的距离为 4.12± 0 .78mm。 2前穿动脉主要来源于大脑前动脉交通前段和颈内动脉终末段 ,穿入前穿质前可分为多支或形成动脉丛。3两侧颈内动脉海绵窦段水平部之间的距离为 16 .48± 4.35 mm,在穿经海绵窦上壁处间距为 13.2 5± 2 .48mm,在大脑前动脉发起处间距为 17.86± 1.5 5 mm。 4前交通动脉在视交叉之上者占 82 .35 % ,之前者占 14.2 9% ,侧方者占 5 .89%。5动眼神经在后床突的前外侧 7.82± 2 .12 mm处穿海绵窦顶入海绵窦 ,入窦点在颈内动脉床突上段后方 4.96±2 .0 2 mm,两侧入窦点之间的距离为 2 1.93± 2 .31mm。认为经纵裂胼胝体前入路垂体瘤切除术主要通过视交叉前间隙 ,在颈内动脉之间操作 ,手术中既要保护颈内动脉、视神经、动眼神经等较大结构 ,又要尽量避免穿动脉、下丘脑支动脉等小动脉的损伤 ,以减少并发症的发生。     

手术治疗121例老年垂体腺瘤临床分析

目的 探讨老年垂体腺瘤的临床特点和手术治疗意义.方法 回顾性分析了121例60岁及以上垂体腺瘤的临床资料.结果 手术主要采用经鼻蝶窦入路,肿瘤全切除及次全切除91例,大部切除25例,部分切除5例.住院期间视力好转80例,占88.9％.随访MRI72例,肿瘤无复发或静止状态67例,复发需再次手术5例.术后生活自理率80％.结论 多数老年垂体腺瘤初期的临床表现隐匿,发现时往往肿瘤大、压迫视神经,尽早鞍区MRI检查可明确诊断.手术切除肿瘤对老年垂体瘤有效、安全,尤其是经鼻蝶入路.     

垂体腺瘤低场强MRI的诊断价值

目的探讨垂体腺瘤的低场强MRI表现。方法对37例患者进行自旋回波序列横轴位、矢状位及冠状位的T1加权和T2加权像,对怀疑微腺瘤的患者用Gd-DTPA造影剂增强扫描。结果垂体大腺瘤表现为等或稍长T1、长T2信号,占位效应明显,常向上累及视交叉（76%）及向两侧侵袭海绵窦。微腺瘤信号及形态改变均不明显,需进Gd-DTPA增强扫描均可确诊。结论低场强MRI对垂体大腺瘤具有重要的诊断价值,动态增强扫描明显提高垂体微腺瘤的检出率。     

垂体微腺瘤的诊断与治疗

对37例垂体微腺瘤患者行经单鼻孔蝶窦入路垂体微腺瘤切除术。对肿瘤的诊断、手术入路、肿瘤切除程度、术后症状和内分泌变化及术后并发症进行了探讨。结果37例均能经MRI检查得到初步诊断。肿瘤均全部切除。术后各种症状均有不同程度改善。26例激素水平恢复到正常（93%）。9例术后发生轻微脑脊液鼻漏,12例术后发生尿崩,均经保守治疗后痊愈。无大出血和感染病例。认为垂体微腺瘤应首选经单鼻孔蝶窦入路垂体瘤切除术。术前准确的诊断和熟练的显微外科操作是提高肿瘤切除率和防止术后并发症的关键。     

单鼻孔经蝶入路与经颅入路手术切除垂体腺瘤疗效对比观察

目的对比观察单鼻孔经蝶（鼻蝶）入路与经颅入路手术切除垂体腺瘤的疗效,探讨垂体腺瘤的良好手术入路。方法48例患者分别采用经鼻蝶入路和经颅入路手术切除垂体腺瘤。结果与经颅入路手术者比较,经鼻蝶入路手术者手术时间短、出血量少、住院时间短、肿瘤全切除率高、激素改变明显、术后并发症发生率低（P均〈0．05）。结论经鼻蝶入路是垂体腺瘤切除的良好手术入路。     

Internal carotid arterial shift after transsphenoidal surgery in pituitary adenomas with cavernous sinus invasion

The intercarotid distance (ICD) between cavernous carotid arteries (CCAs) is an important factor for avoiding injury of the internal carotid artery during transsphenoidal surgery. The ICD between CCAs in pituitary adenoma patients is generally larger than in normal individuals. However, the movement of the CCA during transsphenoidal surgery is not known. The aim of this study is to measure the ICD between CCAs in pituitary adenoma patients before and after surgery. We reviewed 138 pituitary adenoma patients who were treated with resection via the transsphenoidal approach. The CCA diameter and the ICD between CCAs were measured from preoperative and postoperative MR images. The CCA diameter was similar at the preoperative and postoperative time points. On the other hand, the ICD between CCAs was shorter at postoperative time point (19.4 ± 4.5 mm) than at the preoperative time point (20.9 ± 4.9 mm) (P = 0.048). Above all, invasion type adenomas had more significant ICD change at the postoperative time point (23.8 ± 3.8 mm) than at the preoperative time point (21.6 ± 3.9 mm) (P = 0.008). Also in multivariate analysis, cavernous sinus invasion of adenoma was independently associated with ICD contraction >2 mm (P = 0.027). It is important to know the change in ICD between CCAs after transsphenoidal surgery, particularly for pituitary adenomas with cavernous sinus invasion. The position of the CCA should be known before and during transsphenoidal surgery, as well before and during the second operation to avoid vascular injuries.     

Sphenoid sinus pyocele after transsphenoidal approach for pituitary adenoma

Transsphenoidal pituitary adenoma surgery is related to a low morbidity rate. The complications that can occur are classified as intra- and extracranial. The aim of the study is to discuss one group of these complications involving the sphenoid sinus: mucocele and its possible transformation into pyocele. We evaluate clinical presentation, management strategy and the outcome after long-term follow-up presenting an explicative case and a review of the literature. A patient presented to our outpatient clinic 8?months after transsphenoidal surgery for selective removal of a pituitary adenoma because of an acute onset of frontal headache during an airplane travel, fever and pulsating sensation in left eye and ear. MRI revealed a contrast-enhancing lesion in the left inferior portion of the sphenoid sinus. An endonasal endoscopic revision of the sphenoid sinus was performed. After opening of the scar to enter in the left sinus a pyocele was found and treated with drainage and marsupialisation. Development of sphenoid sinus pyocele is an extremely rare postoperative complication of transsphenoidal surgery. This lesion should be taken in consideration in patients presenting with retroorbital headache of acute onset and fever after pituitary surgery. Diagnosis can be suspected on the MRI studies and confirmed by a targeted flexible endoscope examination. Endoscopic drainage with wide opening of the sphenoid sinus and marsupialisation is the treatment of choice to avoid recurrences.     

神经导航系统引导单鼻孔蝶窦入路垂体瘤切除术的应用

目的观察神经导航系统引导单鼻孔蝶窦入路垂体瘤切除术的应用效果。方法32例垂体瘤患者,术前行MRI或CT薄层扫描,将图像资料输入Brain LAB Vector Vision神经导航系统中进行三维重建,据此设计最佳手术入路,并对肿瘤及重要结构作标记;术中在神经导航系统的引导下寻找蝶窦前壁、鞍底、颈内动脉、海绵窦和斜坡等结构,切除肿瘤。结果32例均在神经导航引导下经鼻蝶入路顺利到达肿瘤部位,注册误差0．3～2．5mm;肿瘤全切除24例,次全切除6例,大部切除2例;术后26例症状有不同程度的改善,6例无变化,无严重并发症出现。结论神经导航引导单鼻孔蝶窦入路垂体瘤切除术定位准确、肿瘤全切除率高、并发症少。     

Transient asystole during endoscopic transsphenoidal surgery for Acromegaly: an example of trigeminocardiac reflex

Cardiac arrhythmias are rare during transsphenoidal surgery and is often secondary to stimulation of the trigeminal nerve endings that supply the nasal passages and cavernous sinus walls. Authors report a patient with Acromegaly, who developed transient asystole, during the dissection of the adenoma extending into the left cavernous sinus wall. In such cases, the use of prophylactic atropine may help to avoid such a complication.     

不同剂量瑞舒伐他汀对病窦综合症患者起搏治疗后阵发房颤的影响

目的:观察不同剂量瑞舒伐他汀对病窦综合征(SSS)患者起搏治疗后阵发房颤的影响。方法:选择SSS伴阵发房颤(PAF)患者54例,行双腔起搏治疗后随机分为常规治疗组、瑞舒伐他汀低剂量(低剂量组)和瑞舒伐他汀高剂量(高剂量组),每组18例。12个月疗程后比较3组患者高敏C反应蛋白(hsCRP)水平、左房内径(LAD)和房颤(AF)发生情况。结果:治疗12个月后,与常规治疗组相比,他汀低、高剂量组血浆hsCRP[(4.79±1.62)mg/L比(3.37±1.24)mg/L、(3.31±1.21)mg/L]水平明显降低,AF发生次数[(16.17±4.89)次/年比(7.39±2.68)次/年、(7.44±2.68)次/年]、AF负荷[(30.61±5.65)h/年比(6.33±2.57)h/年、(6.44±2.60)h/年]明显减少,LAD[(40.22±4.91)mm比(36.39±3.29)mm、(36.28±3.53)mm]显著减小(P均<0.05),高、低剂量组疗效上差异无显著性。结论:瑞舒伐他汀可以改善起病窦综合征伴阵发房颤患者双腔起搏治疗后心房重构,减少房颤发生,其疗效与剂量无相关性。     

Prolactinoma of the pituitary containing amyloid

A transsphenoidal operation was performed in a 27 year old man because of a large intrasellar expansion and marked hyperprolactinaemia (33 000 mU/l). The tumour found in the operation bulged into the sphenoidal sinus and was extirpated. On histopathological examination the tumour consisted mainly of congophilic amyloid spherules with intermingled sparse adenoma cells. The adenoma cells were strongly positive for prolactin in immunoperoxidase staining, and in electron microscopy they contained secretory granules. Ultrastructurally the amyloid spherules consisted of masses of concentrical extracellular amyloid filament bundles.     

成人严重骨性Ⅲ类错[牙合]牙颌补偿的研究

目的研究成人严重骨性Ⅲ类错[牙合]矢状和垂直向不调对牙颌代偿的影响。方法选择需接受正颌手术的严重骨性Ⅲ类错[牙合]患者93例,ANB〈-3°。在垂直向不调的研究中根据下颌平面角的大小将患者分为低角（16例）、均角（50例）及高角（27例）三组。通过X线头影测量的方法对颌骨矢向不调与牙[牙合]测量项目做相关性分析。选择SN／AB角与SN／U1角、SN／L1角、SN／OP角对不同垂直向的牙[牙合]代偿进行线性回归分析研究。结果在矢状向与牙[牙合]的相关性分析中,SN／AB与SN／L1的相关性最高（r=0．61）。回归分析表明,SN／AB每改变1°,低角组SN／U1改变0．11°、SN／L1改变0．51°、SN／OP改变0．11°,均角组分别为0．14°、0．40°、0．18°,高角组分别为0．50°、0．95°、0．19°。结论颌骨矢状向和垂直向不调越严重,上切牙代偿性唇倾越多,下切牙代偿性舌倾越多,[牙合]平面代偿性减小越多。     

Hepatocellular carcinoma metastasis to the brain mimicking primary pituitary tumor around the sella turcica

We report on two cases of hepatocellular carcinoma (HCC) with metastasis to the cavernous sinus and sphenoid sinus. Both cases presented with diplopia and retro-orbital headache and both underwent surgery for a primary pituitary gland tumor. After surgery, both cases were diagnosed with metastases from HCC. Case 1 was a 67-year-old male with a history of HCC who was referred to our hospital for pituitary tumor surgery. The tumor appeared to be in the sella turcica and to invade the sphenoid sinus and right cavernous sinus. Transnasal transsphenoidal surgery (TSS) was performed. The tumor was postoperatively diagnosed by histology to be a metastatic pituitary tumor from HCC. Radiotherapy was administered to the metastatic site. Case 2 was a 58-year-old male with a history of TSS for a pituitary tumor 16 years previously. He was referred to our hospital for TSS for a recurrent pituitary adenoma. TSS was performed twice in 3 months. During a preoperative general examination, HCC and chronic hepatitis B were revealed. TSS was performed initially, followed by arterial infusion chemotherapy. After TSS, the pituitary tumor was diagnosed by histology to be a metastasis from HCC. As with Case 1, radiotherapy was administered to the metastasis. Most tumors in the sella turcica are pituitary adenomas, although some cases of metastatic pituitary tumors and skull base metastases have been reported. Distant metastases generally have a poor prognosis; however, surgery to the metastatic site can effectively control symptoms caused by the metastatic tumor.     

Thyroid-stimulating hormone (thyrotropin)-secretion pituitary adenoma in an 8-year-old boy: case report

In this report, an extremely rare case of pediatric thyrotropin-secreting pituitary macroadenoma (TSHoma) is described. An 8-year-old boy, complaining of unsteady gait, was suspected of endocrinopathy because of emaciation and muscle weakness of the legs. Endocrinological work-up established a diagnosis of hyperthyroidism due to syndrome of inappropriate secretion of TSH. Magnetic resonance imaging showed a pituitary macroadenoma with suprasellar and sphenoidal extension without cavernous sinus invasion. He underwent an endoscopic endonasal transsphenoidal adenomectory due to the diagnosis of TSHoma. The adenoma was soft and it was totally removed. Histopathological staining confirmed diagnosis of TSHoma. Postoperative evaluation revealed a subnormal level of TSH (from 13–21 to 0.03 micro U/ml), normalization of alpha-subunit (from 10.0 to 0.09 ng/ml), and as a result, hypothyroidism. The boy left the hospital with oral levothyroxine that continued until 12 months of discharge. The present 8-year-old case is the youngest case to the best of our knowledge based on a bibliographical search. Reasons for endocrinological remission following adenomectomy are (1) correct diagnosis without delay: lack of cavernous sinus invasion, (2) soft and non-fibrous adenoma tissue, and (3) endoscopic technique with wide vision and illumination: safe even for a 8-year-old child. Early recognition/detection and pituitary-conserving adenomectomy can cure TSHoma and avoid long-term medical therapy and/or irradiation, which contribute to the best interests of patients with TSHoma.