微侵袭神经内镜辅助单鼻孔经蝶垂体瘤手术方式的探讨

目的探讨神经内镜技术和手术显微镜结合单鼻孔经蝶微侵袭垂体瘤切除的效果。方法从2003年7月～2005年8月在神经内镜和手术显微镜下单鼻孔经鼻蝶入路切除23例垂体瘤。结果在神经内镜和手术显微镜下全切肿瘤19例,近全切4例,术后21例内分泌化验恢复正常,10例视力好转,4例病人出现暂时性尿崩,2例病人出现脑脊液漏,均于1～2周后恢复。23例病人随访3～16个月,未见复发,无传统唇下入路常见的唇部麻木、鼻中隔穿孔等并发症。结论神经内镜辅助下经鼻蝶入路切除垂体瘤能达到微创的目的,能更好显示鞍上和鞍旁的肿瘤,神经内镜能清晰显示手术显微镜不能看清的部位,而手术显微镜能提供三维视野,在经鼻入路过程及切除鞍区肿瘤的主体等方面具有其优势,二者结合能更安全更完全切除肿瘤。

Minimally Invasive Neuroendoscope-Assisted Single-Nostril Transsphenoidal Microsurgery for Pituitary Adenomas

Objective To assess a minimal invasiveness of the single-nostril transsphenoidal approach assisted by neuroendoscope and microsurgery for pituitary adenomas.Methods Single-nostril transsphenoidal approach with neuroendoscope-assisted and microsurgery pituitary adenomas resection were performed in 23 cases in our department from July 2003 to August 2005.Results Total resection of adenoma were 19 cases and near complete resection were subtotal 4 cases.After surgery,21 cases were restored the normal hormone level;10 cases were recovered the eyesight;4 cases had transient diabetes insipidus and 2 cases had CSF leakage in 2 cases,but all recovered in 1-2weeks.After a follow-up for 3-16 months of 23 patients showed no recurrence,no nasal septal perforation and lip numbness which was often observed in patients undergoing sublabial surgery.Conclusion Neuroendoscope-assisted single-nostril transsphenoidal microsurgery can provide a minimal invasion to cure pituitary adenoma because the neuroendoscope,which allows visualization of areas not seen with the operating microscope.The neuriendoscope should be used in conjunction with the operating microscope that provides three-dimensional visualization.This microsurgery is time saving,providing an excellent exposure for the supra-and parasella tumors and allowing the complete removal of the tumors more safely.