神经导航辅助全程内镜扩大经蝶技术切除复杂蝶斜区病变:附15例报道

目的探讨神经导航辅助全程内镜技术在扩大经蝶入路蝶斜区大型复杂病变切除术中的临床价值。方法复杂蝶斜区病变患者15例,术前采用神经导航系统进行三维重建及注册,术中采用双侧鼻孔扩大经蝶入路,在全程内镜下切除病变。结果术后经病理证实垂体腺瘤7例,脊索瘤5例,海绵状血管瘤3例,10例全切除,4例次全切除,1例大部切除;术后一过性尿崩3例,短暂脑脊液漏2例,无死亡病例;随访时间3~26月,2例未全切病例出现复发并接受放射治疗。结论对于复杂蝶斜区病变的扩大经蝶入路手术,将神经导航与全程内镜技术相结合可充分利用两种技术的优点,有利于提高手术切除率和减少手术并发症。

Surgical resection of complex sphenoclival lesions via a whole-course endoscopic extended transsphenoidal approach under neuronavigation: report of 15 cases

Objective To study the clinical value of the whole-course endoscopic extended transsphenoidal approach assisted by neuronavigation in surgical resection of complex sphenoclival lesions.Methods Image reconstruction and registration were performed for 15 patients with complex sphenoclival lesions using the neuronavigation system,and the bilateral nasal extended transsphenoidal approach was adopted to remove the lesions with a whole-course endoscopic procedure.Results Postoperative pathological examination reported pituitary adenomas in 7 cases,chordomas in 5 cases,and cavernous angiomas in 3 cases.Total removal of the lesions was achieved in 10 cases,subtotal removal in 4 cases,and partial removal in 1 case.Transient polyuria occurred in 3 cases and 2 patients experienced temporary cerebrospinal rhinorrhea.No death occurred in these cases after the operation.During the follow-up ranging from 3 to 26 months,only 2 patients with partial lesion removal showed recurrence and received subsequent radiotherapy.Conclusion The combination of whole-course endoscopic technique and neuronavigation can help improve the surgical outcomes and reduce complications of complex sphenoclival lesion removal via the extended transsphenoidal approach.