眶上锁孔入路内窥镜辅助切除鞍上蔓延性垂体瘤及锁孔修复

目的 探索眶上入路、内窥镜辅助微创手术治疗鞍上蔓延性垂体瘤及锁孔修复的方法与技巧。方法 2001年2月～2003年3月，对9例鞍上蔓延性垂体瘤患者行眶上锁孔入路、显微镜下切除直视肿瘤部分，再辅用神经内窥镜经1、2间隙切除残余肿瘤。小骨瓣复位后用一枚钛钉固定。结果 常规显微镜下切除肿瘤后，经神经内窥镜探查时发现7例仍有不同程度的残瘤，辅用内镜进一步切除，6例全切除，3例次全切除。术后1周7例视力改善，2例无变化，无手术致残及死亡。6例随访6～22个月，半年后生活完全自理，恢复正常工作，视力提高0．3～0．5，3例激素恢复正常。6例复查MRI显示鞍区结构恢复良好，无肿瘤复发。骨窗修复稳固，且无切口并发症。结论 眶上锁孔人路可提供足够的颅内外操作空间；内窥镜辅助微创术提高了肿瘤的全切率及成功率，且有利于神经功能保护和减少并发症。用钛钉固定小骨瓣安全可靠，骨窗修复良好。

RESECTION OF EXTENSIVE PITUITARY ADENOMA VIA SUPRAORBITAL KEYHOLE WITH ENDOSCOPE-ASSISTED MICRONEUROSURGERY

OBJECTIVE: To study the methods and techniques of the treatment for extensive suprasellar pituitary adenona and repairing hole. METHODS: From Feb. 2001 to Mar. 2003, 9 patients with exrensive suporasellar pituitary adenoma underwent resection via suprabital keyhole with endoscope-assisted microneurosurgery. Then the remaining tumor was removed with neuroendoscope via I and II space of optic chiasma. The small bone flap was fixed with Ti clamp. RESULTS: After the tumor was removed with microneurosurgery, the remaining tumor was still found with endoscope in 7 cases. Remaining tumor was totally removed in 6 cases, almost removed in 3 cases. The vision improvement was found in 7 cases one week after surgery. In the other 2 cases, the vision remained unchanged. Follow-up was conducted in 6 cases for 6 to 22 months. Neuroradiological recovery of MRI with no recurrence of tumor was observed. No complication of incision was present. CONCLUSION: Enough intra and extra-cranial space can be provided to operate via orbital roof approach to sellar tumors. Endoscope-assisted microneurosurgery can increase the total-resection and successful rate treatment for extensive suprasellar pituitary adenoma, reduce the possibility of complication, and pretect the function of brain from being injured. Fixation of small bone flap with Ti clamp is safe, easy and reliable.