神经导航在经蝶显微切除侵袭性鞍区肿瘤手术中的应用

目的 评价神经导航技术在经蝶显微切除侵袭性鞍区肿瘤手术中的应用价值。方法 在18例经蝶手术中，应用Stealstation神经导航系统指导手术，明确手术方向、肿瘤边界、肿瘤切除程度。术后均通过MRI验证肿瘤切除率。结果 18例肿瘤中，全切除或次全切除14例，大部分切除4例，均无严重术后并发症。结论 应用神经导航技术能扩大经蝶显微手术适应证，提高侵袭性鞍区肿瘤的切除率，减少手术并发症。     

经额入路行蝶鞍区肿瘤手术的应用解剖

目的　为经额入路蝶鞍区肿瘤切除术提供解剖学资料。方法　采用解剖技术对 35个甲醛固定 ,红色明胶动脉灌注的尸头标本蝶鞍区的有关结构进行观察。结果　两侧视神经管颅口内缘间距为 11.0 9± 2 .2 2mm ,视交叉前缘至交叉前沟前缘间距为 7.0 2± 1.86mm。垂体上面与鞍隔平面有三种位置关系 :垂体上面通过鞍隔孔露出鞍隔平面以上者 3例 ( 8.75% ) ,在鞍隔平面以下者 13例 ( 37.14% ) ,与鞍隔平面平齐者 19例 ( 54.2 9% )。两侧颈内动脉在穿经海绵窦上壁处间距为 13.2 5± 2 .4 8mm ,大脑前动脉发起处 ,两侧颈内动脉之间距为 17.86± 1.55mm。结论　经额入路蝶鞍区肿瘤切除术主要是通过交叉前间隙 ,在颈内动脉之间的区域操作 ,手术中要保护颈内动脉、视神经等结构 ,以减少并发症的发生     

前纵裂入路切除鞍区巨大肿瘤

背景与目的：鞍区巨大肿瘤手术难度较大，本文探索前纵裂入路切除鞍内、鞍上向单双侧海绵窦、第三脑室、蝶窦及伴颞叶发展的巨大肿瘤的手术适应症、方法与优缺点方法：总结分析2002年1月至2004年5月我科经前纵裂入路切除鞍区各部位发展的肿瘤17例。结果：肿瘤全切14例，近全切2例．部分切除1例；术后视力改善12例，无改变5例，尿崩或电解质紊乱8例，死亡1例，随访时间3～32个月，有1例复发，系巨大侵袭性垂体瘤术后，行γ-刀治疗后肿瘤基本得到控制。结论：前纵裂入路是切除鞍内、鞍上向单双侧海绵安、第三脑室、蝶窦及伴颞叶发展的肿瘤较理想的入路，利用自然脑裂的分离，手术视野、操作角度好、肓区少，有利于显露重要血管、神经及双侧海绵窦内侧壁，肿瘤全切率高。     

Rathke’s cleft cyst: A case report of recurrence and spontaneous involution

Rathke’s cleft cysts (RCC) are sellar lesions that typically remain asymptomatic throughout life. Symptomatic patients present with headache, visual disturbance and/or pituitary dysfunction and are treated with resection. We present a 61-year-old woman diagnosed with RCC which was resected twice then recurred before undergoing spontaneous resolution. RCC are often managed without surgical intervention. Some of these lesions may spontaneously resolve without surgical intervention while others may become symptomatic. In patients with asymptomatic recurrent RCC conservative management is recommended. Spontaneous involution may occur following initial resection and recurrence of RCC.     

鞍区毛细胞黏液样星形细胞瘤MRI表现

目的观察发生于鞍区的毛细胞黏液样星形细胞瘤(PMA)的MRI特点。方法回顾性分析经手术病理证实的21例PMA的MRI表现。结果 MRI图像上,21例PMA具有如下特点:肿瘤均呈不规则分叶状,边界清楚,体积较大[最大径29.13~73.25mm,平均(47.52±15.33)mm],肿瘤最长轴多为腹背方向(11/21,52.38%)。MR平扫肿瘤病灶信号多不均匀,T1WI多呈等、低信号(16/21,76.19%),T2WI多呈高信号(21/21,100%),部分内见低信号(13/21,61.90%)。增强扫描肿瘤多为明显不均匀强化(20/21,95.24%),常可见多发微小囊样表现(11/21,52.38%)。21例中,20例发生脑积水,9例发生蛛网膜下腔播散。结论 PMA的MRI表现具有一定的特征性,应用多种MR检查方法,结合患者的年龄及临床表现,有助于其术前诊断。     

鞍区大型肿瘤不同显微手术入路的疗效评估(附82例报道)

目的 探讨和评估大型鞍区肿瘤不同手术入路的疗效. 方法 福建医科大学附属漳州市医院神经外科和上海同济大学附属仁济医院神经外科自2004年1月至2012年1月采用不同的手术入路治疗鞍区大型肿瘤患者82例,其中双额底内侧入路32例,单鼻孔经蝶入路32例,扩大的翼点入路12例、单侧额下外侧入路6例,评估不同入路的结果和预后. 结果 本组肿瘤全切除66例,次全切除16例,其中经双额底内侧入路肿瘤全切除28例(87.5％),次全切4例;单鼻孔经蝶经入路肿瘤全切除26例(81.2％),次全切6例;扩大的翼点入路肿瘤全切除9例(75％),次全切3例;单侧额下外侧入路肿瘤全切除3例(50％),次全切3例.无手术死亡患者. 结论 鞍区大型肿瘤的切除可根据肿瘤类型选用经扩大的翼点入路或双额底内侧入路,单鼻孔经蝶入路主要适用于垂体腺瘤.     

鞍区病变侧方经颅手术入路的研究进展

当前神经外科的进步得益于手术精确性的不断提高,显微解剖及入路的研究是精细手术技术不断发展的基础。鞍区因其位置较深、解剖结构复杂、毗邻重要的生命中枢且手术操作空间有限,因此手术难度极高,鞍区同时也是垂体瘤、颅咽管瘤、脑膜瘤及前循环动脉瘤等的好发部位。目前常用于处理鞍区病变侧方经颅手术入路依据骨窗大小及位置的不同主要分为:翼点入路、眶上外侧入路,在此基础上发展的微创锁孔入路及联合手术入路。该文就目前常用的鞍区侧方经颅手术入路的研究进展进行综述。     

Chemical meningitis: A rare presentation of Rathke’s cleft cyst

Rathke’s cleft cysts (RCC) are usually benign, sellar and/or suprasellar lesions originating from the remnants of Rathke’s pouch. Rarely, RCC can present with chemical meningitis, sellar abscess, lymphocytic hypophysitis, or intracystic hemorrhage. We describe an unusual presentation of RCC in which the patient presented with a clinical picture of chemical meningitis consisting of meningeal irritation, inflammatory cerebrospinal fluid profile, and enhancing pituitary and hypothalamic lesions, in addition to involvement of the optic tracts and optic nerve.     

单鼻孔经蝶内镜下鞍区肿瘤手术效果的临床分析

目的：分析单鼻孔经蝶内镜下鞍区肿瘤手术的临床效果。方法资料随机选取2010年6月-2013年6月本院行择期手术治疗的120例鞍区肿瘤患者,按照随机数字表法分为两组,对照组60例予以开放性手术治疗,研究组60例予以单鼻孔经碟内镜下手术治疗,分析两组患者围术期相关性指标、肿瘤切除及症状改善情况。结果研究组患者手术时间、术中出血量及住院时间均明显少于对照组,患者肿瘤全切除38（63.33%）例明显多于对照组20（33.33%）例,部分切除6（10.00%）例明显少于对照组14（23.33%）例;研究组患者头晕、闭经、阳痿、泌乳及视力恢复等临床症状改善情况均明显多于对照组,比较差异均具有统计学意义（P〈0.05）。结论单鼻孔经蝶内镜下鞍区肿瘤手术的临床效果显著,有效改善患者的临床症状,提高手术治疗有效率。     

Clinical and pathological features of 124 patients with indistinguishable sellar lesions and central diabetes insipidus

BackgroundSellar lesions with central diabetes insipidus have a wide range of causes, and diagnosis is relatively difficult. The indication and clinical value of biopsy are still controversial.ObjectiveTo describe the etiology, demographic characteristics, manifestations, laboratory tests and imaging findings of this disease and to explore the clinical value and safety of endoscopic transsphenoidal biopsy.MethodsRetrospective analysis of 124 patients with sellar lesions and central diabetes insipidus who underwent endoscopic transsphenoidal biopsy at the Neurosurgery Department, Peking Union Medical College Hospital, from 2011 to 2019.ResultsThe main etiology includes congenital diseases, inflammatory/infectious diseases and tumor diseases. The most common diseases were germ cell tumors, Langerhans cell histiocytosis, lymphocytic hypophysitis, and Rathke's cleft cysts. Except for the age at the time of biopsy of patients with tumor diseases, which was significantly lower than that of the other two, the other clinical manifestations of the three types of diseases were not significantly different. Among the 124 patients, biopsy was performed via an endoscopic transsphenoidal approach for 101 with intrasellarly available lesions or via an endoscopic extended transsphenoidal approach for 23 with intrasellarly unavailable lesions. 6 patients had central nervous system infections after surgery, and 3 had cerebrospinal fluid rhinorrhea, of which 2 were surgically repaired. These incidences were basically the same as those of classic surgery. 2 patients had worse visual acuity, 2 had worse visual field, and 2 had worse eye movement. Excepting one patient, all of whom have recovered after treatment.ConclusionsNoninvasive examination is difficult for identifying the common causes of this type of disease. Endoscopic transsphenoidal biopsy is relatively safe and effective, helps doctors to select the best treatment for patients, and is worth promoting.