内镜经扩大鼻蝶入路切除鞍上肿瘤的临床分析

目的探讨内镜经扩大鼻蝶入路切除鞍上肿瘤、鞍内向鞍上或向前颅底扩展肿瘤的安全性和有效性。方法回顾性分析了2013年11月~2015年7月内镜经扩大鼻蝶入路切除鞍上肿瘤、鞍内向鞍上或前颅底扩展肿瘤17例；其中颅咽管瘤6例、向鞍上或前颅底扩展垂体瘤9例、垂体柄朗格罕斯组织细胞增生症1例、视交叉海绵状血管瘤1例。结果14例（14/17，82.4%）全切除，2例颅咽管瘤近全切除,1例颅咽管瘤次全切除后接受伽马刀治疗。15例术前视力下降，14例（14/15，93.3%）术后视力改善；1例（6.7%）术后视力障碍加重，2周后恢复至术前水平。11例术前皮质醇正常，2例(2/11，18.2%)术后出现一过性降低。2例生长激素增高，术后正常。1例（1/17，5.9%）垂体瘤术后脑脊液鼻漏，二次手术修补。随访3~24个月，MRI未见肿瘤复发，无死亡患者。结论内镜经扩大鼻蝶入路从腹侧显露和切除鞍上肿瘤，视野清晰、无脑牵拉损伤，能更好地保护神经功能，是切除鞍上肿瘤的一种安全、有效的方法。

Extended endoscopic endonasal transsphenoidal approach for removal of suprasellar tumors

Abstract:ObjectiveTo investigate the safety and efficacy of extended endoscopic endonasal transsphenoidal approach (EEETA) for removal of suprasellar tumors and sellar tumors with suprasellar extension.MethodsBetween Nov 2013 and July 2015, 17 consecutive patients underwent removal of suprasellar tumors or sellar tumors with suprasellar extension via EEETA. This series consisted of six craniopharyngiomas, nine pituitary adenomas, one Langerhans cell histiocytosis of pituitary stalk and one cavernoma of chiasm.ResultsTotal gross removal was achieved in 14 patients (82.4%), almost total removal was achieved in two patients with craniopharyngioma, and one patient with the subtotal removal of craniopharyngioma received gamma knife therapy. Of 15 patients with preoperative visual acuity defects, 14 (93.3%) got improved obviously, and one worsened after operation. Of 11 patients with normal preoperative cortisol level, 2 (18.2%) suffered temporary decrease after operation. Two patients with high growth hormone had normal postoperative pituitary function. One patients (5.9%) with adenoma suffered cerebrospinal fluid rhinorrhea. During the 3 to 24 months follow up period, postoperative magnetic resonance images revealed no tumor recurrence, and no patient died.ConclusionWith advantages of clear vision, better exposure, without brain retraction, safe resection of suprasellar tumors ventrally, and preservation of neurological function, EEETA is safe and effective for resection of suprasellar tumors.