CTVE技术在神经内镜经鼻蝶窦垂体腺瘤手术中的应用价值

目的探讨CTVE技术在神经内镜经鼻蝶窦垂体腺瘤手术中的应用价值。方法在20例行鼻蝶窦垂体腺瘤手术患者中,对常规术前垂体CT检查数据进行CTVE重建,将其用于术前计划以及术中定位。对CTVE显示的鞍底三维图像与术中显微镜所见图像进行对比分析。结果 CTVE能以三维图像的形式对鞍底解剖结构进行显示,对解剖结构：蝶窦内隔、鞍底、颈内动脉隆起、视神经管隆起以及O-C隐窝的显示率分别为100.00%、100.00%、42.50%、40.00%及72.50%,均显著高于术中显微镜显示范围;通过对观察阈值的调高,CTVE可以清楚地显示鞍底深面的颈内动脉、垂体组织、部分视神经管,通过二维图像,可准确地标出肿瘤在CTVE图像上的具体部位。结论 CTVE可显示蝶窦以及鞍底的表面解剖标志同深面结构的三维解剖之间的关系,在经鼻蝶窦垂体腺瘤手术中,CTVE能够很好地指导术前计划以及术中定位。

Analysis of the application value of CTVE technique through nasal transsphenoidal nervous endoscopic surgery for pituitary adenoma

Objective To evaluate the application value of of CTVE technique through nasal transsphenoidal nervous endoscopic surgery for pituitary adenoma.Methods In 20 patients with pituitary adenoma,who underwent the routine nasal sphenoid surgery,the conventional pituitary CT scan data were preoperatively reconstructed with CTVE,which were applied for the preoperative planning and intraoperative localization.The three-dimensional images on the saddle displayed by CTVE and intraoperative findings with microscope were analyzed.Results CTVE was able to display the anatomical structures of the saddle bottom via a three-dimensional image.The rates in displaying the anatomical structure of the saddle bottom in terms of sphenoid sinus septum,sellar,internal carotid artery bulge,the optic canal swelling,and OC crypts with CTVE were 320.00%,100.00%,42.50%,40.00%,and 72.50%,respectively,which were significantly higher than these displaying with microscope intraoperatively.Through the increase in the observation threshold,CTVE could clearly show the dark side of the saddle at the end carotid artery,pituitary tissue,and the part of the optic canal.Two-dimensional image with CTVE could be accurately indicated on the exact location of the tumor Conclusion CTVE can show the three-dimensional anatomical relationship of anatomic landmarks between the sphenoid and the bottom surface of saddle with deep surface structure.For the sphenoid sinus nasal surgery on pituitary adenoma,CTVE can be a good guidance for preoperative planning and intraoperative localization