内镜下经鼻蝶入路治疗儿童及青春期垂体腺瘤

目的探讨儿童及青春期垂体腺瘤的临床特点和内镜下手术治疗。方法回顾性分析31例20岁以下垂体腺瘤病人的临床资料,其中泌乳素腺瘤14例,促肾上腺皮质激素腺瘤8例,生长激素腺瘤6例,无功能性腺瘤3例。均行内镜下经鼻蝶入路垂体腺瘤切除术。结果肿瘤全切除28例,次全切除3例。手术并发症：暂时性尿崩症4例,脑脊液漏2例,水电解质紊乱4例。随访6个月～5年,治愈26例,缓解3例,复发2例。结论儿童及青春期垂体腺瘤多为功能性腺瘤,无功能腺瘤仅占少数。内镜下经鼻蝶入路手术是治疗儿童和青春期垂体腺瘤安全、有效的方法。     

儿童及青少年垂体泌乳素腺瘤的临床特点及手术疗效

目的探讨儿童及青少年垂体泌乳素腺瘤的临床特点及手术治疗效果。方法回顾性分析36例儿童及青少年垂体泌乳素腺瘤病人的临床资料。术前影像学检查显示:微腺瘤4例,大腺瘤27例,巨大腺瘤5例;侵袭性腺瘤9例,均行经鼻蝶窦入路手术。结果肿瘤全切除32例(88.9%),次全切除4例(11.1%)。随访30例,时间1年,复发5例,其中药物治疗2例,再次手术治疗2例,放疗1例。结论经鼻蝶窦入路手术是儿童及青少年垂体泌乳素瘤的有效治疗方法。肿瘤具有侵袭性生长及复发倾向,术后可继续应用药物治疗,需定期复查垂体MRI及内分泌激素以评估肿瘤复发情况。     

垂体腺瘤手术预后因素研究之一——83例垂体腺瘤的硬脑膜侵犯情况分析

目的:研究垂体腺瘤硬脑膜侵犯与其它复发因素的关系。方法:对83例经蝶入路显微手术的垂体腺瘤病人术中采集硬脑膜标本作病理检查,并分析所有病人的临床资料。结果:垂体腺瘤的硬脑膜侵犯率为68.7％,催乳激素(PRL)腺瘤、生长激素(GH)腺瘤、无功能性腺瘤、垂体腺瘤卒中的硬脑膜侵犯率分别为70.45％、57.89％、75％、77.27％;肿瘤越大者硬脑膜侵犯率越高;有硬脑膜侵犯者卒中率高。结论:垂体腺瘤有硬脑膜侵犯者易于复发。术中应常规送检鞍底硬脑膜,以病理上发现有硬脑膜侵犯作为术后放疗或药物治疗的依据。     

神经内镜手术治疗垂体肿瘤的临床疗效分析

目的探讨经鼻蝶入路神经内镜下切除垂体肿瘤的临床疗效。方法回顾性分析98例经鼻蝶入路神经内镜治疗的垂体腺瘤的临床资料,其中无功能性腺瘤44例,泌乳素腺瘤32例,生长激素腺瘤8例,促肾上腺皮质激素腺瘤3例,促性腺激素腺瘤6例,多分泌性腺瘤5例。结果肿瘤全切除62例,次全切除23例,部分切除13例。平均手术时间115 min,平均术后住院时间5.7 d。术后第1天复查垂体激素水平,提示激素水平恢复正常37例。术后出现并发症13例,经对症处理后恢复。无再次手术与死亡病例。术后随访3个月,视力、视野障碍好转40例,头痛、头晕缓解51例,月经恢复正常20例。结论经鼻蝶神经内镜治疗垂体肿瘤,能够全程直视下切除肿瘤,肿瘤切除率高,并发症发生率较低,可缩短住院时间,具有较好临床治疗效果。     

单鼻腔经蝶入路显微手术切除垂体腺瘤

目的总结单鼻腔经蝶入路显微手术治疗垂体腺瘤的手术经验。方法回顾性分析458例垂体腺瘤病人的临床资料,其中无功能腺瘤167例,混合性腺瘤34例,功能性腺瘤257例。均行单鼻腔经蝶入路显微切除垂体腺瘤。结果肿瘤全切除306例,次全切除117例,部分切除35例。术后临床症状均有不同程度改善,术后发生难治性尿崩3例,脑脊液漏11例,脑出血2例,感染2例,视力下降3例,鼻出血2例。随访3个月～5年,复发58例,复发率12.7%。结论单鼻腔经蝶入路手术是垂体腺瘤的首选治疗方法。     

内镜经鼻垂体腺瘤切除术

目的 探讨内镜经鼻垂体腺瘤切除术的外科技术.方法 总结2003年9月至2006年3月100例内镜经鼻垂体腺瘤手术病人的临床资料.其中微腺瘤30例,大腺瘤35例,巨大腺瘤35例.功能性腺瘤68例,无功能性腺瘤32例.头痛82例,视力减退伴视野缺损76例,失明3例,闭经、泌乳36例,肢端肥大26例,垂体功能低下15例,其他症状者6例.结果 术中内镜下肿瘤全部切除93例,大部切除7例,7例均为质地硬韧的纤维型腺瘤.术后短暂性尿崩症32例;脑脊液鼻漏5例.术后随访平均28个月,肿瘤残余者10例;12例肿瘤复发,10例再次行经蝶手术,2例行开颅手术;术后内分泌症状改善不明显者,有11例行溴隐亭治疗,18例病人行伽玛刀治疗.结论 内镜经鼻垂体腺瘤切除术是一种安全、有效、微创的外科技术.     

术前MRI判断垂体腺瘤质地及其与胶原含量的对照

目的探讨术前MR I判断垂体腺瘤质地的可能性,及其与肿瘤胶原含量的关系。方法57例经手术证实的垂体腺瘤标本,根据术中肿瘤硬度分为质地韧(纤维化)组8例与质地软(非纤维化)组49例,所有病例术前均行MR I检查并测量T1加权像(T1W I)、T2加权像(T2W I)、T1增强像(T1 W I)上肿瘤与灰、白质的信号强度比(瘤体/灰质、瘤体/白质);标本行天狼猩红染色检测其胶原含量。结果纤维化与非纤维化组T W I瘤体/灰质分别为1.31±0.31、1.16±0.26;T1W I瘤体/白质分别为1.01±0.25、0.91±0.18,两组间无显著统计学差异(P>0.05)。T1 W I瘤体/灰质分别为1.83±0.28、1.84±0.51;T1 W I瘤体/白质分别为1.56±0.24、1.46±0.37两组间无显著统计学差异(P>0.05)。T2W I瘤体/灰质分别为1.15±0.26、1.57±0.46(P<0.05);T2W I瘤体/白质分别为1.48±0.39、2.10±0.61(P<0.01)两组间有显著统计学差异。胶原含量分别为20.03%±7.99%、7.87%±4.82%,两者有显著统计学差异(P<0.01);且T2W I瘤体/灰质、T2W I瘤体/白质与胶原含量呈显著负相关(r=-0.531、r=-0.726,P均<0.01)。结论术前MR I可以预测垂体腺瘤的质地;其中以T2W I瘤体/白质作预测指标为最佳,T2W I瘤体/白质小于1.9者提示腺瘤质地较硬。胶原含量影响垂体腺瘤质地,MR I上T2W I瘤体/白质、T2W I瘤体/灰质可以反映其胶原含量的多少。     

儿童及青少年垂体促肾上腺皮质激素腺瘤的临床特点及手术治疗效果

目的探讨儿童及青少年垂体促肾上腺皮质激素腺瘤的临床特点及手术治疗效果。方法回顾性分析1987年12月至2014年12月北京协和医院收治的50例儿童和青少年垂体ACTH腺瘤患者的临床特点、内分泌学检查、影像学检查、肿瘤分型、手术入路、术后并发症及随访结果。结果 50例中男21例(42.0%),女29例(58.0%),年龄10~18岁,平均发病年龄15.5岁,平均病程45.5个月。术前影像学检查显示:微腺瘤40例(80.0%),大腺瘤10例(20.0%);侵袭性腺瘤4例(8.0%);均行经鼻蝶窦入路手术。肿瘤全切除48例(96.0%),次全切除2例(4.0%);随访时间1年,其中44例(88.0%)获得完整随访,7例(15.9%)在术后1年内复发或未缓解再次接受手术治疗。结论经鼻蝶入路手术是儿童及青少年垂体促肾上腺皮质激素腺瘤的首选和有效治疗方法,治疗效果良好。该病具有复发倾向,需要定期复查垂体MRI及垂体内分泌激素,复发者可行再次手术或放射治疗。     

磁共振信号特征与垂体腺瘤质地的关系

目的探讨磁共振平扫的信号特征与垂体腺瘤质地的关系。方法112例经手术和病理确诊的垂体腺瘤根据手术中肿瘤的质地分为3组:质软组(A组,78例),质中等组(B组,15例)和质韧组(C组,19例),所有病例术前均行磁共振扫描,通过JW-PACS影像工作站测量MR值,分别计算T2加权成像的瘤体/灰质比值(T/G)和瘤体/脑脊液比值(T/C)。结果3组的T/G分别为1.643±0.079,1.328±0.086,0.973±0.050,其差异有统计学意义(P=0.000);T/C分别为0.755±0.052,0.623±0.047,0.472±0.050,其差异均有统计学意义(P=0.000)。结论术前磁共振T2WI的信号强度可区分垂体腺瘤的质地,对判断手术难度和预后及选择手术入路有重要意义。     

扩大经蝶窦入路治疗侵袭性垂体腺瘤(附117例病例分析)

目的 探讨扩大经蝶窦入路治疗侵袭性垂体腺瘤的疗效.方法 回顾性分析采用扩大经蝶窦入路治疗117例侵袭性垂体腺瘤病例,对其疗效进行分析.结果 肿瘤向前方及额叶底部生长14例,向侧方生长包绕海绵窦103例,向后方生长破坏斜坡27例,突破鞍底向蝶窦生长45例,向两个方向以上的呈侵袭性生长者57例.手术显微镜下肿瘤全切除73例,次全切除40例,大部切除4例.手术并发症包括短暂性脑脊液鼻漏7例;脑神经不全麻痹5例;垂体功能低下5例;颈内动脉损伤2例;单眼失明2例;水久性尿崩症1例;无死亡病例.随访3个月-8年,2例患者出现肿瘤复发而予γ-刀治疗,无再手术病例.结论 采用扩大经蝶窦入路切除侵袭性垂体腺瘤,肿瘤显露满意,全切除率高,手术并发症少;但对于肿瘤未能完全切除或激素分泌型侵袭性腺瘤患者,仍需密切随访,必要时联合放射、药物等综合治疗.     

儿童和青春期垂体腺瘤的经蝶手术治疗

目的探讨年龄小于17岁的儿童及青春期垂体腺瘤的诊断及其经蝶窦显微外科手术治疗。方法本组20例(垂体PRL腺瘤7例，ACTH腺瘤5例，GH腺瘤4例，无功能腺瘤4例)均行经蝶窦显微外科垂体腺瘤切除术。结果肿瘤全切除18例，部分切除2例；随访8个月～8年，治愈75％，缓解25％，复发5％；常见并发症为尿崩症(25％)和电解质紊乱(25％)。结论经蝶窦垂体腺瘤切除术是治疗儿童及青春期垂体腺瘤的安全有效的方法：     

经蝶窦手术治疗巨大垂体腺瘤

目的探讨经蝶窦手术治疗巨大垂体腺瘤的临床效果。方法从2005年3月至2008年12月,采用经蝶窦分次手术治疗直径大于4cm的巨大垂体腺瘤46例,其中无功能腺瘤24例,泌乳素腺瘤9例,生长激素瘤10例,促肾上腺皮质激素腺瘤1例,混合性腺瘤2例。结果本组患者1次手术31例,2次手术12例,3次手术3例。分次手术间隔为6～8W。全切除26例,次全切除20例。术后并发垂体功能低下2例,脑脊液漏2例,术后肢体偏瘫1例。无死亡病例。l例在手术后2年肿瘤复发。结论经蝶窦手术能有效治疗巨大垂体腺瘤。分次经蝶窦手术能有效提高手术全切除率并减少术后并发症。     

垂体腺瘤的三维重建及形态特性分析

目的 通过对垂体腺瘤进行三维影像重建,探讨肿瘤形态特征及相关因素.方法 连续收集直径大于10mm的垂体腺瘤58例,其中经鼻蝶窦入路手术52例,经翼点入路手术6例;根据患者术前MRI表现,对其向蝶鞍周围扩展的程度进行分级,并运用虚拟现实技术对肿瘤进行三维模型重建及形态分类.结果 所有患者均重建了肿瘤、颈内动脉及脑组织结构.垂体腺瘤三维模型分为鞍内型（13.8％）、鞍上型（20.7％）、鞍下型（17.2％）和分叶型（48.3％）.鞍内型腺瘤均为功能型,而鞍上型、鞍下型、分叶型腺瘤中,功能型分别占75％、60％和60.7％.不同形态的肿瘤,其间质地、囊变、鞍底硬脑膜是否存在侵袭,均无统计学差异.结论 虚拟现实技术重建的垂体大腺瘤三维模型,能简单、直观地反映肿瘤与毗邻结构的空间关系,三维模型半数呈分叶状,腺瘤形态与其质地、囊变及侵袭性均无明显关系.     

巨大型侵袭性垂体腺瘤67例分析

目的　研究巨大型侵袭性垂体腺瘤的临床特点及治疗方法。　　方法　回顾性分析 67例巨大型侵袭性垂体腺瘤 ,并与 2 2例非侵袭性垂体腺瘤比较。　　结果　巨大型侵袭性垂体腺瘤临床表现以内分泌紊乱多见 ,头痛、视力视野损害的发生率明显高于对照组 ,并较对照组更多出现侵犯颅外和周围脑组织引起的各种症状。CT值为 52 2Hu ;MRT1 加权呈等信号或混杂信号 ,T2 加权高信号多见 ,混杂信号次之。本组全切除加次全切除率为 61 2 % ,以扩大额下硬膜外入路及经额入路的效果较好。术后并发症和肿瘤复发率高于对照组 ,生活质量低于对照组。　　结论　巨大型侵袭性垂体腺瘤临床表现复杂 ,影像学检查信号特殊 ;提高肿瘤的全切除率及术后常规放疗是提高疗效的重要措施。     

原发性垂体柄占位性病变的诊断和手术治疗(附10例报告)

目的：探讨垂体柄占位性病变的影像学诊断及手术方法。方法：回顾性分析10例垂体柄占位性病变的MR资料，其中男4例，女6例，平均年龄32岁。结果：MR的特征性表现为垂体柄球形增粗，3例生殖细胞瘤，T1、T2等信号，强化均匀一致，其中，1例经手术病理证实，3例均行放射治疗，疗效明显；7例Rathke’s囊肿，T1等、低信号，T2高信号，包膜环形强化，均行手术切除病理证实诊断。结论：MR可以清楚的显示原发性垂体柄占位形态，有别于继发性病灶，生殖细胞瘤放疗疗效肯定。     

Endoscopic transsphenoidal treatment of pituitary adenomas

BACKGROUND AND PURPOSE: The aim of this study is to present a new endoscopic transnasal transsphenoidal method of surgical treatment of pituitary adenomas and to evaluate the results and complications of the method. MATERIAL AND SURGICAL TECHNIQUE: From October 2001 to June 2003 in the Department of Neurosurgery of the Medical University of Silesia in Katowice 88 operations of pituitary adenomas were performed using the transnasal transsphenoidal endoscopic method. The group of patients consisted of 50 females and 38 males. The youngest patient was 11 years old and the oldest was 79 years old. Patients were operated on using the 4-mm diameter endoscope with 0- and 30-degree angled lenses, using a method of operation according to Jho and Carrau with own modifications. At the time of surgery the operation team included 2 neurosurgeons, an anesthesiologist and a laryngologist. RESULTS: In the group of 51 nonfunctioning adenomas, in 32 cases we obtained the total removal of the tumor, which amounts to 63%. Among 37 of hyperfunctioning adenomas there were 11 prolactinomas, 19 GH secreting adenomas and 7 ACTH secreting adenomas. In all cases of prolactinomas the tumor was removed totally and in the cases of GH secreting adenomas and ACTH secreting adenomas the total removal of the tumor was performed in 58% and 86% of the cases, respectively. One patient within our group died after the operation. It was the patient with a huge nonfunctioning macroadenoma, with hydrocephalus and preoperative disturbances of consciousness. The permanent diabetes insipidus occurred in 2 cases, which amounts to 2.3% of all operated patients. In this group we noticed the intraoperative CSF leakage in 20 cases but we did not observe the postoperative CSF leakage or any rhinological complications. CONCLUSIONS: The endoscopic transnasal transsphenoidal approach is an efficient method of surgical treatment of pituitary adenomas. The advantage of this method is low invasiveness and a small number of serious complications.     

Cognitive function surrounding resection of nonfunctioning pituitary adenomas with suprasellar extension: A prospective matched-control study

ObjectivePatients suffering from pituitary adenomas may experience cognitive dysfunctions due to hormonal imbalance or suprasellar tumor extension displacing neural structures. Progressively enlarging or symptomatic nonfunctioning pituitary adenomas with suprasellar extension are frequently resected. The literature on neurocognitive performance surrounding resection of these lesions is sparse.MethodsA prospective matched-control study was conducted to investigate the impact of nonfunctioning pituitary adenomas with suprasellar extension on preoperative and postoperative cognitive performance. Controls were matched for age, sex, handedness, education, and profession. The neurocognitive test battery included perceptual speed, executive function, visual-spatial and verbal working memory, short- and long-term memory, verbal fluency, fluid intelligence, anxiety, and depression.ResultsTen patients and 10 healthy controls were matched. Median suprasellar tumor extension scored 8 mm, compression of frontal lobe parenchyma was present in all cases. Median sagittal tumor diameter was 21 mm. Preoperatively, patients scored worse in perceptual speed and short-term memory tasks. All patients underwent surgical resection either through a transnasal, transsphenoidal approach or a supraorbital frontolateral keyhole approach. The short-term memory deficit disappeared one week after surgery. Perceptual speed recovered within two months after surgical therapy. None of the patients experienced worsening of cognitive function. Routine postoperative imaging at six months did not reveal displacement of neural structures or surgery-related complications in any of the patients.ConclusionPatients suffering from nonfunctioning pituitary adenomas with suprasellar extension may experience preoperative impairments in some neurocognitive domains that resolve within two months after surgery. The risk for cognitive deterioration with surgery appears to be low.     

垂体腺瘤囊变和囊内液平面形成的MRI特征及相关因素分析

目的探讨垂体腺瘤囊变及液平面形成的MRI特征及其临床相关因素。方法连续收集83例经手术和病理证实的垂体腺瘤，术前行MRI评估，结合手术所见和病理发现进行研究。结果MRI表现囊变者43例，其中19例无液平面的囊变区多表现为T。WI低或稍低信号，T1WI高信号；24例液平面上／下信号表现为T1WI上呈高／低信号19例，高／等信号4例，低／等信号1例；T1WI上仅7例发现液平面，其中高／等信号4例，高／略高信号2例，略低／等信号1例。垂体腺瘤囊变及液平面形成与肿瘤大小、侵袭性有关（P〈0．05），多见于泌乳素型、促性腺激素型、无功能型和多激素型腺瘤。结论垂体腺瘤囊变及液平面形成主要是因瘤内出血后，血肿衍化吸收沉淀所致。术前对垂体腺瘤囊变及液平面的MRI评估有助于对肿瘤生长方式及行为的判断。     

巨大垂体腺瘤二次经蝶手术30例分析

目的探讨巨大垂体腺瘤二次经蝶手术策略、技巧及术后并发症处理方法。方法回顾性分析30例巨大垂体腺瘤二次经蝶手术病人的临床资料,对手术切除程度、术后症状、激素水平变化及并发症处理等进行总结和分析。结果术后病理结果显示：无功能性腺瘤22例,其中无功能性促肾上腺皮质激素腺瘤1例;生长激素腺瘤8例。功能性垂体腺瘤病人术后激素水平均不同程度下降。术后并发一过性尿崩症9例,脑脊液鼻漏4例,无死亡或严重并发症病例。术后3个月行MRI复查17例,肿瘤全切除4例,次全切除7例。部分切除6例。结论对单纯经蝶或经颅入路均无法一期全切除或术后随访肿瘤复发的巨大垂体腺瘤病例．二次经蝶手术应作为首选治疗方法。     

Magnetic resonance imaging (MRI) of pituitary adenomas

MRI of 20 patients, 17-82 years old, with pituitary adenomas confirmed histopathologically, and 30 normal patients without pituitary dysfunction were reviewed. The studies were performed with a 0.5 Tesla MR scanner with a slice thickness of 10 mm. Inversion recovery sequences were employed as T 1-weighted examination, with repetition time (TR) of 2100-2500 msec, an inversion time (TI) of 600 msec and an echo time (TE) of 40 msec. The T 2-weighted examination had a TR of 1800-2500 msec and a TE of 120 msec. T 1-weighted images were obtained in all cases and T 2-weighted images in 14 cases. Spin echo images with a TR of 600-1000 msec and a TE of 40 msec (SE 40/600-1000) were also obtained in 14 cases. On T 1-weighted images, 20 adenomas were classified into six groups, according to their signal intensities; marked low intensity (1), low intensity (1), isointensity (11), high intensity (3), marked high intensity (1) and mixed intensity (3). On T 2-weighted images, 14 adenomas were classified into five groups; low intensity (1), isointensity (2), high intensity (4), marked high intensity (6) and mixed intensity (1). On SE 40/600-1000 images, 14 adenomas were also classified into four groups; low intensity (8), high intensity (2) and mixed intensity (3). Two adenomas with recent intratumoral hemorrhage had marked high intensity on both T1 and T2-weighted images. SE 40/600-1000 images were useful in evaluating the size and the extent of the visual pathway was best appreciated on IR images. Comparison between normal and involved cavernous sinus by adenomas was made.