神经内镜下经鼻蝶入路垂体腺瘤手术的鞍底解剖复位技术及其早期预后

目的介绍神经内镜下经鼻蝶入路制作可解剖复位的鞍底带蒂粘膜骨瓣的手术方法。初步探讨其使用范围及早期预后。方法回顾性分析2015年4月~11月在南京军区南京总医院神经外科应用鞍底带蒂粘膜骨瓣进行鞍底解剖复位的病例38例。术中暴露鞍底后仔细辨认双侧颈内动脉隆起、视神经隆起及颈内动脉视神经隐窝。在上述解剖结构内侧马蹄形切开鞍底粘膜,磨开鞍底骨质并向下翻开,形成鞍底带蒂粘膜骨瓣。肿瘤切除以后,复位鞍底粘膜骨瓣并用生物蛋白胶固定,实现鞍底的解剖复位。结果 32例患者完成鞍底解剖复位。9例术中脑脊液漏患者,无一发展为术后脑脊液漏。所有病例术后均未发生粘膜骨瓣相关并发症。结论鞍底带蒂粘膜骨瓣是一项安全、有效的鞍底解剖复位方法。

Anatomic reposition of sellar floor and its early results after endoscopic endonasal transsphenoidal pituitary surgery

Objective To introduce the surgical technique of making the pedicledmucoperio-steum flap of sellar floor after endoscopic transsphenoidal pituitary surgery.The application of the flap and its early results were described.Methods The clinical data of 38 patients underwent sellar anatomic reconstruction using the pedicledmucoperiosteum flap of sellar floor in Jinling Hospital were analyzed retrospectively.Taken care to identify the carotid protuberance,the optic protuberance and the optocarotid recess after exposingsellar floor.The mucoperiosteum of sellar floor was incised in a horseshoe shape in these anatomic landmarks.Then the bone of sellar floor was opened and fractured down.The pedicledmucoperiosteum flap of sellar floor was accomplished.After tumor resection, the fibrin glue was used to help secure the flap in the anatomic position.Results 32 patients undergoing endoscopic pituitary adenoma surgery were reconstructed using the pedicledmucoperiosteum flap of sellar floor.Intraoperative CSFleakage was encountered in 9 patients, none of these cases developed into postoperative CSF leak.No other postoperative complication was occurred.Conclusion The pedicledmuco-osteal flap of sellar floor is a safe and effective reconstructive method.