经蝶显微外科手术治疗发生脑脊液鼻漏的垂体腺瘤

目的：总结自发性脑脊液鼻漏的垂体腺瘤的临床特点和经蝶手术治疗的方法。方法：分析经蝶手术治疗发生脑脊液鼻漏的垂体腺瘤6例的临床资料。结果：6例5例为巨大型泌乳型垂体腺瘤，1例为伴有空蝶鞍的垂体无功能腺瘤，3例以脑脊液鼻漏为首发症状。术后随访3月至6年，4例肿瘤全切除，2例次全切除，脑脊液鼻漏全部治愈。结论：发生脑脊液鼻漏的垂体腺瘤多见于巨大型漏乳素垂体腺瘤；也可见于垂体腺瘤伴有空蝶鞍者；放疗、服溴隐停治疗可促进垂体腺瘤发生脑脊液鼻漏。经蝶入路是最佳手术入路；肿瘤切除后严密填塞蝶窦是修补鼻漏的关键措施，术后腰穿蛛网膜下腔持续引流有利于修补瘘口的愈合。

Treating pituitary adenomas associated with spontaneous cerebrospinal rhinorrhea with transsphenoidal microscopic surgery

Objective:To discuss the clinical features and transsphenoidal surgical management of pituitary adenomas associated with cerebrospinal fluid (CSF) rhinorrhea.Method:The clinical data of six patients with pituitary adenomas with CSF rhinorrhea treated by transsphenoidal microscopic surgery were reviewed.Results:In six patients,5 were giant prolactinomas and 1 was nonfunctioning pituitary adenoma coexisting with a partially empty sella;and 3 patients presented CSF rhinorrhea as the initial symptom.Followed up from 3 months to 6 years,4 patients accepted total tumor removal, 2 cases accepted subtotal removal,the CSF rhinorrhea disappeared in all of these patients.Conclusion:CSF rhinorrhea can occur spontaneously in patients with giant pituitary adenomas,or less frequently,in patients with pituitary adenomas coexisting with partially empty sellas,and treatment of pituitary adenomas with radiatoin or bromocriptine may precipitiate rhinorrhea.Microscopic surgical treatment by transsphenoidal approach is the most suitable for these patients;packing sphenoid sinus hermetically after tumor removal is an effective method to obliterate the cerebrospinal fluid rhinorrhea;resting in bed with draining CSF continously via a lumbar subarachnoid catheter after operation are helpful in healing the repairs.