单纯神经内镜下经单鼻腔-蝶窦入路手术治疗垂体腺瘤

目的 总结我科单纯神经内镜下经单鼻腔-蝶窦入路切除垂体腺瘤的手术经验,探讨该手术方式的优越性.方法 对经CT或MRI诊断为垂体腺瘤的42例患者(肿瘤直径<1cm11例,1～2 cm 11例,2～3cm 18例,>3cm 2例)采用经单鼻腔-蝶窦入路手术,术中不切除鼻中隔,直接打开蝶窦前壁,经鞍底切除垂体腺瘤.结果 全切除38例,次全切除4例.视力、视野均较术前有所恢复.6例术后出现一过性脑脊液漏,23例发生暂时性尿崩.术后18例内分泌检查恢复正常,4例随访激素水平下降.结论 单纯神经内镜下经单鼻腔蝶窦入路切除垂体腺瘤,具有手术创伤小、照明好、安全、提供360度全景的术野且并发症少.操作时间短,术后康复快等优点.该术式值得进一步推荐应用.

Treatment of pituitary adenomas by simple neuroendoscopic surgery via endonasal transsphenoidal approach

Objective To summarize our experience of simple neuroendoscopic endonasal transsphenoidal surgery for pituitary adenoma and discuss its advantages. Methods Forty-two patients with pituitary adenoma diagnosed by CT or MRI detection (diameters of the tumor: <1cm in 11 patients, 1-2cm in 11, 2-3cm in 18, >3cm in 8) were treated by simple neuroendoscopic endonasal transsphenoidal surgery. During transsphenoidal approach, the nasal mucosa was not incised and the nasal septum and median nasal conchae were not dissected. Under neuroendoscopic assistance, the anterior wall of the sphenoidal sinus and sellae base was opened directly and adenoma resection was performed. Results All the patients were followed up for 1-12 months. By postoperative MRI detection, adenomas were resected completely in 38 patients, subtotally in 4 cases. Rapid improvement of vision was noted postoperatively. The increased hormonal level in 18 of 22 patients was decreased to normal postoperatively and another 4 cases improved clinically in serum hormone levels during follow-up. Postoperative transient CSF leakage occurred in 6 cases and transient diabetes insipidus in 23 cases. Conclusions The simple neuroendoscopic endonasal transsphenoidal surgery for pituitary adanoma is safe, time-saving and without severe complications, provides a satisfactory deep illumination and a panoramic operative field. The injury to the patient and postoperative complications are less. The clinical application of the neuroendoscopy for pituitary adenoma is worthy of recommending.