垂体腺瘤的MRI表现与经蝶入路术中所见分析

目的　探讨垂体腺瘤的MRI表现对判断肿瘤质地的意义 ,侵袭性腺瘤的判断 ,以及经蝶入路切除垂体腺瘤的可行性和有效性。方法　回顾分析 2 0 0例经蝶入路手术垂体腺瘤患者的临床资料、MRI信号特点及手术情况。结果　 138例T2 像为高信号 ,肿瘤质软 ;T2 像呈稍高信号 2 4例 ,质地中等 ;T2 像呈等、低信号 38例 ,肿瘤质韧。术中发现有侵袭征象 12 6例 ,病理报告显示 139例鞍底硬膜被肿瘤侵袭 ,5 2例蝶窦粘膜有肿瘤侵袭。手术全切除肿瘤 170例 ,次全切除 17例 ,部分切除 13例。术前有视力障碍的患者 ,98%术后得以改善 ;功能性腺瘤患者术后 95 %以上激素水平恢复正常 ;无严重并发症。结论　MRI检查T2 像信号强度与垂体腺瘤的质地有关 ,显微镜下的侵袭性大多数在术中也可发现侵袭的征象 ;经蝶入路显微切除垂体腺瘤 ,即使是巨大腺瘤也是安全有效的。

MRI manifestation and surgical findings of transsphenoidal surgery in pituitary adenomas patients

Objective To study the significance of MRI manifastation in the judgment of pituitary adenomas consistence and invasive adenomas as well as the practicability and effectiveness of adenomaectomy by transsphenoidal approach.Methods Clinical data of 200 cases treated by transsphenoidal approach,MRI signal characteristics and operation were retrospectively analyzed.Results T 2 MR signal was long and adenomas was soft in 138 cases;T 2 MR signal was longer and adenomas was moderately soft in 24 cases;T 2 MR signal was equal and shorter and adenomas was hard in 38 cases.Intraoperative invasive signs were found in 126 cases.Pathology report showed that the sellar floor dural in 139 cases and sphenoidal sinus mucosa in 52 cases were invasive.170 cases underwent total resection,17 cases subtotal resection and 13 cases partial resection.98% of patients who had sight dysfunction before operation were improved postoperativly.Over 95% of hormone level of functional pituitary adenomas patients recovered normal.No case developed severe complication.Conclusion There is relationship between the signal of T 2 weight and pituitary adenomas consistence.Most microscopic dural invasion may also be found in surgery.The transsphenoidal approach is safe and effective in pituitary adenomaectomy and even in very large or giant adenomas.