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William T. Couldwell 《Journal of neuro-oncology》2004,69(1):237-256
This paper reviews the progress made over the first century of pituitary surgery. The goals of surgery for pituitary tumors are to eliminate tumor mass effect and perform as complete a removal as possible, retain pituitary function, and normalize any hormonal hypersecretion. Since the initial transsphenoidal approach performed in Austria by Schloffer, the transsphenoidal approach has become the preferred surgical approach to most pituitary tumors. The history and development of the transsphenoidal approach to the sella is discussed, as are the contemporary techniques of microscopic and endoscopic pituitary surgery. The continued evolution of the variations and extension of the transsphenoidal approach to other lesions are reviewed. The indications and use of a transcranial approach to remove pituitary tumors are discussed. More recently, stereotactic radiosurgery (SRS) has become an important adjuvant management technique in the management of difficult pituitary adenomas, especially with cavernous sinus invasion. 相似文献
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目的探讨垂体瘤患者采用内镜辅助下经鼻蝶入路手术治疗的临床疗效。方法选取90例垂体瘤患者,按照随机数字表法分为对照组(经鼻前庭-鼻中隔-蝶窦垂体瘤切除术)与观察组(内镜辅助下经鼻蝶入路手术),各45例。比较两组患者术中出血量、肿瘤残留、肿瘤体积缩小程度及内分泌激素下降比例。结果观察组术中出血量和肿瘤体积缩小程度及内分泌激素下降比例分别为(83.9±11.7)ml、(90.3±12.2)%、(85.9±12.1)%,与对照组[(351.2±42.8)ml、(53.7±7.4)%、(41.9±8.6)%]比较,差异具有统计学意义,P<0.05;观察组肿瘤残留率(4.4%)明显低于对照组(31.1%),差异具有统计学意义,P<0.05。观察组治疗优良率明显高于对照组,而术后并发症明显少于对照组,差异具有统计学意义,P<0.05。结论应用内镜辅助下经鼻蝶入路手术治疗垂体瘤疗效明显优于经鼻前庭-鼻中隔-蝶窦垂体瘤切除术,且具有较高安全性,因此可值得推广应用。 相似文献
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背景与目的:近年来随着内镜光学技术的发展和五官科医生在鼻窦手术中广泛使用内镜.内镜在经蝶窦垂体腺瘤外科中的应用逐渐被熟知。本研究主要探讨神经内镜下再次经蝶窦手术治疗复发垂体腺瘤的安全性及临床疗效。方法:对12例经蝶手术后复发的垂体瘤患者进行了内镜下再次经蝶切除术。观察其安全性、肿瘤切除情况及手术并发症等。结果:内镜下全切除8例。次全切除2例。大部分切除2例。本组术后无死亡及严重并发症,常见并发症为一过性尿崩症、电解质紊乱和脑脊液鼻漏,术后83%(10/12)患者临床症状明显改善.12例随访6个月至5年,疗效满意。结论:神经内镜下再次经蝶窦手术治疗复发性垂体腺瘤是安全有效的.而熟练的内镜技术和可靠的颅底重建是手术成功的关键。 相似文献
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背景与目的:单鼻孔经蝶入路垂体腺癌切除术已较为成熟,本文探讨神经导航系统在单鼻孔经蝶入路垂体腺瘤切除术中的应用。方法:在46例垂体腺瘤患者中,应用导航系统辅助手术,术前对患者行核磁共振连续薄层扫描,将影像信息导入神经导航系统进行解剖学三维重建,术中对肿瘤及周围重要结构实时定位,判断肿瘤的切除范围。结果:本组23例患者中肿瘤全切除38例,次全切除8例。术后30例内分泌学指标恢复正常,32例头痛好转,20例视力好转,16例出现一过性尿崩症,均无出血、视力、视野障碍、脑脊液漏、颅内感染等并发症。结论:神经导航系统在手术中定位准确,可以实时准确的指示术区的有关解剖结构.并引导手术操作,有效地减少了创伤,提高了手术疗效。 相似文献
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鼻内窥镜和术中磁共振在经蝶垂体瘤手术中的应用 总被引:1,自引:0,他引:1
神经外科医生一直在努力追求垂体瘤手术微创且有效的途径。近年来鼻内镜和术中磁共振技术发展迅速,两者均促进了垂体瘤手术的发展,它们的结合在垂体瘤手术中是可行的。本文对鼻内窥镜和术中磁共振在经蝶垂体瘤手术中的应用作一介绍。 相似文献
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Rhinosinusitis/mucocele are rare complications of transsphenoidal surgery. We present a retrospective analysis of 323 patients
who received transsphenoidal surgery for pituitary adenoma. Twenty of the 323 patients (6.2%) developed rhinosinusitis/mucocele
after transsphenoidal surgery as shown by MRI. All 20 patients with rhinosinusitis/mucocele occurred in the group who received
the small sphenoidotomy approach and simple postoperative nasal care. Medical management was successful in 13 of 20 cases
(65%). The remaining seven patients received endoscopic sphenoidotomy. On re-operation, purulent pus was discovered in two,
a necrotic fat graft in one, mucocele in one, a dropped tumor in two, and a bone chip in one. Sphenoid sinusitis resolved
in all seven cases. The formation of sphenoid sinusitis/mucocele is related to the size of the sphenoidotomy, frequency of
postoperative nasal care, and foreign body accumulation. Early surgical drainage is necessary in patients with rhinosinusitis/mucocele
refractory to medical management to prevent ascending meningitis.
Yu-Jen Lu and Chen-Nen Chang have equally contributed to this article. 相似文献
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内镜经鼻蝶入路手术治疗大型垂体腺瘤 总被引:2,自引:0,他引:2
背景与目的:对于大型垂体腺瘤,传统的开颅和经蝶入路手术均难以全切,本文探讨内镜经鼻蝶入路切除大型垂体腺瘤的手术技术。方法:回顾性分析2000年9月-2005年12月间治疗的大型垂体腺瘤患者39例,术前均行头CT、MRI及内分泌学检查,手术采用内镜经鼻蝶入路肿瘤切除术。结果:本组患者无手术死亡,肿瘤全切除23例(60.0%),近全切除14例(35.9%),部分切除2例(5.1%)。术后随访6—24个月,症状和内分泌学指标均有所改善,肿瘤复发2例。结论:内镜经鼻蝶手术是治疗大型垂体腺瘤微创、安全的方法。 相似文献
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目的:探讨经单鼻孔蝶窦入路显微手术治疗垂体腺瘤的经验与方法。方法:回顾总结显微镜下单鼻孔经蝶窦入路切除46例垂体腺瘤,观察手术效果和并发症。具体手术方法是:将鼻窥器缓慢插入右鼻孔向上经中鼻甲直至蝶窦前壁,横行切开鼻中隔黏膜约1.5cm,保持窥器尖呈闭合状态向对侧偏移,使鼻中隔骨折移位。然后将窥器张开,此时在显微镜下即可见中线骨性隆起结构蝶嵴及两侧蝶窦开口。以蝶嵴及两侧蝶窦开口为标志,凿除蝶窦前壁约1.0~1.5cm,显露蝶窦腔,咬除蝶窦分隔,剥离电凝蝶窦黏膜,显露凸形鞍底,凿开并咬成1.2~1.5cm骨窗既见硬脑膜,电凝硬膜后穿刺,证实肿瘤后“十”字切开,显露肿瘤并予钳取和刮除。通常肿瘤切净后可见鞍隔塌陷,彻底止血,冲洗术腔,放入明胶海绵填塞。结果:手术过程顺利,肿瘤全切除34例,次全切除12例,无死亡及病残发生,激素水平均有明显改善,17例出现一过性尿崩症,5 例出现电解质紊乱,术后无脑脊液鼻漏发生。结论:不断改进的单鼻孔经蝶窦入路具有入路简捷、操作方便、安全高效的优点。 相似文献
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目的探讨显微镜和神经内镜下经单鼻孔蝶窦入路切除垂体瘤的临床应用和优缺点。方法对24例经CT扫描和MRI检查确诊为垂体瘤的患者在显微镜或神经内镜下经单鼻孔蝶窦入路直视下予以切除。结果显微镜组:10例全切除,2例大部分切除;内镜组:11例全切除,1例大部分切除。两组患者术后症状均有不同程度的改善,无严重并发症发生。结论内镜经鼻蝶垂体瘤手术中具有良好的深部照明及全景化的视野等优点,较显微镜下经单蝶入路切除垂体瘤的过程中更微创,提高了肿瘤的全切率,但两种术式都应该熟练掌握,根据不同的患者灵活地选择术式。 相似文献
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Hengzhu Zhang Xian Zhang Hongmei Du Yongkang Wu Lun Dun Lei She Xiaodong Wang Xueqiang Shi Cunlin Xu 《中国肿瘤临床(英文版)》2009,6(6)
OBJECTIVE To explore the methods and experience of the single-nostril transsphenoidal approach for treating pituitary adenomas.METHODS We retrospectively analyzed 46 patients who had pituitary tumors and received surgery via the single-nostril transsphenoidal approach and observed the effects and complications of surgery. The specific surgical methods are: a nasal speculum is inserted slowly through the right nostril towards the anterior wall of the sphenoid sinus. A 1.5 cm incision is made into the nasal mucosa in the right nasal cavity at the level of the middle nasal turbinate. By fracturing the bony septum, a space is formed between the bilateral nasal mucosa and the bony septum of the sphenoid sinus. Then, the inside of the sphenoid sinus is exposed. The remaining part of the bony septum, the anterior sphenoid sinus wall, and the sphenoid mucosa are gradually removed. The anterior sphenoidotomy is less than 1.5 cm wide. After confirming the tumor by dural puncture, a cross incision of the dura is made, and the tumor is slowly removed by curette. The sella is usually collapsed and visible after the total tumor removal. When the tumor is resected satisfactorily, gelatin sponges are placed into the operative cavity to stop bleeding.RESULTS Postoperative MRI scans revealed that among the 46 cases, total resection of the tumor was achieved in 34 cases and subtotal in 12. No deaths or disability occurred, and the hormone levels of almost all patients improved. Signs of diabetes insipidus occurred in 17, electrolyte disturbances in 5, and there were no reports of postoperative cerebrospinal fluid rhinorrhea. CONCLUSION The direct single nostril transsphenoidal approach of continuous improvement has the advantages of a convenient approach, simplified operation, safety and high efficiency. 相似文献
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Lee Min Ho Hur Kyu Yeon Hong Sang Duk Seol Ho Jun Choi Jung Won Lee Jung- Il Nam Do-Hyun Kong Doo-Sik 《Journal of neuro-oncology》2021,153(2):343-350
Journal of Neuro-Oncology - The role of transsphenoidal surgery in the recovery of preexisting hormone dysfunction from pituitary tumors remains controversial. This study aimed to investigate the... 相似文献
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背景与目的:1992年Jankowski等首次在内镜下行经鼻蝶入路垂体瘤切除以来,经过十几年的探索和努力,内镜经鼻蝶、扩大经鼻蝶入路肿瘤切除术日趋成熟,广泛应用于垂体瘤、脊索瘤等颅底肿瘤的切除。该术式安全、微创、有效,并发症的发生率远低于传统术式,但出血性血管损伤是该术式最严重的并发症之一,如处理不当可明显影响患者预后,本文将着重探讨该入路肿瘤切除术术中、术后出血原因及对策。方法:对111例单鼻孔内镜下经蝶、扩大经蝶入路肿瘤切除术病例进行回顾性分析,其中垂体瘤91例,脊索瘤9例,Rathe囊肿5例.颅咽管瘤3例,骨纤维结构不良1例,血管网状细胞瘤1例,骨软骨瘤1例。结果:肿瘤全切92例(82.9%),次全切16例(14.4%),部分切除3例(2.7%);术中出血〈200ml92例(82.9%),〉200ml17例(15.3%),〉1000ml2例(1.8%);术后鼻衄2例(1.8%);术后鞍上血肿4例(3.6%)。结论:单鼻孔内镜下经蝶入路、扩大经蝶入路肿瘤切除术术中、术后出血为该入路严重的并发症。应通过正确操作、及时处理避免其发生。 相似文献