巨大不规则型垂体腺瘤的显微外科手术治疗

目的探讨巨大不规则型垂体腺瘤不同手术入路选择的临床意义，总结出针对不同生长形态肿瘤的较好的手术入路和治疗方案。方法根据66例巨大不规则型垂体腺瘤的临床病史特点和CT、MRI等影像学表现，详细制定手术治疗方案，并按照肿瘤的不同生长形态选择合适的手术入路，部分术中采用神经导航和神经内窥镜辅助技术。结果本组病例分别采用6种不同手术方案，全切除10例，次全切除51例，大部切除1例，部分切除4例。手术死亡4例。结论术前应根据病史和影像学资料、肿瘤的生长形态以及累及的解剖腔隙，选择合理的手术入路和治疗方案，避免对鞍区重要解剖结构的损伤，才能取得较好的临床疗效。神经导航和神经内窥镜辅助技术有助于提高肿瘤的切除率。

Microsurgical strategies for the giant and irregular pituitary adenomas

Objective To evaluate the clinical significance of the different optional operation approaches for the giant and irregular pituitary adenomas (GIPAs) and to summarize the optimal surgical approaches and strategies for the adenomas with various growing forms.Methods A total of 66 patients with GIPAs were treated by studying their clinical features and radiological images, formulating the operation program in details, choosing the suitable approach according to different growing forms of the adenomas. Moreover, neuronavigation and neuroendoscope techniques were applied in the operations. Postoperative MRI and endocrine function were re-examined routinely to judge the therapeutic efficacy of various surgical approaches including the combined approaches and staging operations.Results Among all cases respectively undergone 6 different surgical strategies, total removal was achieved in 10 cases, subtotal removal in 51 cases, major removal in 1 case, partial removal in 4 cases, and 4 patients died.Conclusion The suitable approach, which was based upon case history and radiological data, the growth configuration of adenomas, and involving anatomic lacunas, can reach the best therapeutic results and can avoid injury to the vital anatomy structures. The resection rate can be improved with the aid of neuronavigation and neuroendoscope techniques.