解剖标志及神经内镜下经单鼻孔-蝶窦入路治疗脑垂体瘤

目的总结解剖标志及神经内镜下经单鼻孔-蝶窦路径进行垂体瘤切除的手术方法及其疗效。方法回顾分析42例经蝶内镜切除垂体瘤的手术经验。患者行磁共振成像(MRI)或CT扫描检查,显示鞍区肿瘤并压迫视神经与视交叉。均采用经单鼻孔-蝶窦路径、在神经内镜辅助下摘除。结果肿瘤全切除38例,近全切除3例,大部分切除1例。手术无死亡病例。本组随访3~36个月,平均10个月。18例视力下降及缺损者中,16例(88.9%)视力迅速恢复,2例(11.1%)好转。视野缺损14例(77.8%)恢复,4例(22.2%)改善。19例术前异常增高的激素水平术后部分逐渐恢复正常,20例术前内分泌功能紊乱者术后症状缓解。结论解剖定位及神经内镜下经单鼻孔-蝶窦路径切除垂体瘤是一种安全、有效的微侵袭手术方法。

Endonasal transsphenoidal surgery under anatomic landmark neuroendoscope for pituitary adenoma

Objective To review the surgical techniques and effect of endonasal transsphenoidal approach under anatomic landmark for neuroendoscopic removal of pituitary adenoma.Methods The experience with endoscopic endonasal transsphenoidal surgery under anatomic landmark was retrospectively reviewed in 42 cases of pituitary adenoma,in which preoperative CT or MRI showed sellar masses causing optic nerve and optic chiasmal compressions.Results Total removal was achieved in 38 cases,subtotal in 3 cases,and partial removal in 1 case with tumor.No death occurred after surgery.The whole set was followed for a median of 10 months with a range of 3-36months.Rapid recovery of visual acuity was in 88.9% patients(16/18) with visual acuity impairment and moderate improvement in 11.1% patients(2/18).Among patients with preoperative visual field defects,postoperative recovery was achieved in 77.8% patients(14/18) and improvement in 22.2% patients(4/18).Abnormal hormone level in 19 patients returned normally and symptoms of endocrine functional disorder in 20 patients were also relieved after surgery.Conclusion The endonasal approach with the neuroendoscope under anatomic landmark may be a safety and effective minimally invasive method for pituitary adenoma removal.