应用神经导航辅助技术在内镜下切除伴有甲介、鞍前型蝶窦的垂体腺瘤

背景与目的：多数学者认为伴有甲介、鞍前型蝶窦的垂体腺瘤不适合内镜下切除．但应用神经导航辅助技术可以克服其在内镜下手术的缺陷。本文着重探讨应用神经导航辅助技术在内镜下切除伴有甲介、鞍前型蝶蜜的垂体腺瘤。方法：回顾性分析我院自2004年10月至2008年10月应用神经导航技术对伴有甲介、鞍前型蝶窦变异的垂体瘤进行内镜下单鼻孔手术21例。其中生长激素腺瘤4例．高泌乳素腺瘤6例，促肾上腺皮质激素腺瘤7例，无功能性腺瘤4例。蝶窦冠状CT及蝶窦X线平片提示蝶窦形态，甲介型9例。鞍前型12例。术前行头部CT、MRI扫描，术中神经导航定位，在内镜下经单鼻孔切除肿瘤。结果：术后随访6．24个月，术前症状（视力受损、尿崩症）均在术后消失，血液、内分泌指标均在正常范围内。术后随访1年以上的病例（17例）复查MRI均提示未见肿瘤残留或复发。术后所有病例均未出现颅内出血、视力、视野障碍、尿崩、脑脊液漏、颅内感染等并发症。结论：对于伴有甲介、鞍前型蝶窦变异的垂体瘤手术．应用神经导航辅助内镜能确保术中定位准确，术野大且直观。有利于切除肿瘤．并保护周围重要结构．

Application of Endoscopic Neuronavigation in the Transsphenoidal Resection of Pituitary Adenoma Accompanied by Conchal or Presellar Sphenoid Sinus

BACKGROUND ＆ OBJECTIVE： Transsphenoidal endoscopic approach is not generally considered suitable for pituitary adenoma accompanied by conchal or presellar sphenoid sinus. In present article, we investigated the applications of endoscopic neuronavigation in the transsphenoidal resection of pituitary adenoma accompanied by conchal or presellar sphenoid sinus. METHOD： The clinical data of 21 cases with pituitary aderaoma accompanied by eonchal or presellar sphenoid sinus, treated with trans-sphenoidal approach under endoscopic neuronavigation, from October 2004 to October 2008 in our hospital, were retrospectively analyzed. Among those 21 cases, four cases were diagnosed with growth hormone （GH） adenomas, 6 cases with prolactin （PRL） adenomas, 7 cases with adrenocorticotropic hormone （ACTH） adenomas and 4 cases with nonfunctional adenomas. Coronal CT scans and X-ray films of the sphenoid sinuses suggested 12 cases with presellar sphenoid sinus and 9 cases with eonchal sphenoid sinus. Brain CT scanning and MR were performed before surgery. Tumor resection through trans-sphenoidal approach was performed under the guidance of endoscopic neuronavigation. RESULT： After six to twenty four months follow-up study on those patients, we found that all of the preoperative symptoms, such as impairment of the eyesight and diabetes insipidus, disappeared after operation. The endocrine indexes are all within the normal range. MR scanning demonstrated no residual or recurrent tumor in seventeen cases after one-year follow-up. No postoperative complications, such as intracalvarium bleeding, impairment of visual sight, visual field deficit, diabetes insipidus, leakage of cerebralspinal fluid and intracranial infection, were observed. CONCLUSION： Endoscopic neuronavigation surgery is safe for pituitary adenomas accompanied by conchal or presellar sphenoid sinus. Endoscopic neuronavigation provide facilitate the resection of pituitary tumors and the protection of adjacent structures.