侵袭型垂体腺瘤的分期手术治疗

目的探讨采用分期手术治疗侵袭型垂体腺瘤的临床意义,总结出针对不同生长方式肿瘤的较好的分期手术方法.方法根据25例侵袭型垂体腺瘤的临床病史特点和CT、MRI等影像学表现,详细制定手术治疗方案,并按照肿瘤的不同生长形态选择合适的分期手术入路,术中采用神经内镜和神经导航辅助技术.结果本组病例根据生长方式不同可分成4种类型,分别采用相应不同的分期手术方案,全切除15例,次全切除7例,大部切除3例.死亡1例.结论手术前应根据病史和影像学资料,肿瘤的生长形态,累及的解剖腔隙,选择合理的分期手术方法,避免对鞍区重要解剖结构的损伤,才能取得较好的临床治疗效果.神经内镜和神经导航技术有助于提高手术切除率.

The study of staged operations for the invasive pituitary adenomas

Objective To evaluate the clinical significance of the staged operations for the invasive pituitary adenomas and to summarize the optimal staged operation approaches to the adenomas growing in various forms.Methods Twenty five cases of invasive pituitary adenoma were treated by studying their clinical features and radiological images, formulating the operation program in details, choosing the suitable staged operation approach according to the various growth forms of the adenomas. Moreover, neuroendoscope and neuronavigation assisted techniques were applied in the operations. Postoperative MRI was examined routinely to judge the effect of various surgical approaches.Results All the tumors could be divided into 4 types with corresponding different staged operations . Total removal was achieved in 15 cases, subtotal removal in 7 cases, major removal in 3 cases and one patient died.Conclusion The suitable chosen staged operation approach, which was based upon case history and radiological data, the growth configuration of adenomas and involved anatomic lacunas, can reach better clinical therapeutic results and avoid injury to the vital anatomy structures. The resection rate can be improved with the help of neuroendoscope and neuronavigation techniques.