颅咽管瘤手术中垂体柄的辨认与保护

目的 探讨颅咽管瘤手术中垂体柄的辨认与保护方法及其对预后的影响。方法 对63例颅咽管瘤病人垂体柄的影像学和术中表现进行分析。结果 术中明确发现垂体柄33例,位于肿瘤瘤体后方23例、上方5例、侧方3例、前方2例。23例可在影像学上初步判断垂体柄与肿瘤的位置关系,均得到术中证实。垂体柄得到辨认与保护者术后尿崩的恢复好于术中未见垂体柄者。结论 垂体柄的辨认与保护对提高肿瘤全切除率、改善预后至关重要,MRI扫描可以为术中主动寻找及保护垂体柄提供帮助。

Identification and Preservation of Pituitary Stalk in Surgical Treatment of Craniopharyngiomas

Objective To explore the intraoperative identification and preservation of the pituitary stalk and their effects on prognosis in the patients with craniopharyngiomas. Method The radiological and intraoperalive appearances of the pituitary stalks were analyzed in 63 patients with craniopharyngiomas. Results The pituitary stalks, which were intraoperatively identified in 33 patients, were posterior to the tumors in 23 patients, superior in 5, lateral in 3 and anterior in 2. The pituitary stalks were identified by preoperative MRI in 23 patients and were intraoperatively confirmed. The postoperative diabetes insipidus in the patients with pituitary stalks identified and presered were less servere than that in the patients with intraoperatively unidentified pituitary stalks. Conclusions The identification and preservation of the pituitary stalk play a vital role in total tumor removal and improvement of prognosis in the patients with craniopharyngiomas. The preoperative MRI is helpful to identififcation of the pituitary stalks.