经颅入路显微手术切除大型、巨大型垂体腺瘤

目的 探索手术全切除大型、巨大型垂体腺瘤的有效方法。方法 28例垂体腺瘤患者，男性19例，女性9例。年龄24岁－48岁，平均36岁。以视力障碍起病15例，月经紊乱、闭经、泌乳5例，性欲减退2例，头痛6例。MRI检查肿瘤最大直径≥2cm者13例；最大直径≥4cm者15例。其中19例经翼点入路，6例经额下入路，3例经扩大翼点入路切除肿瘤。术中根据肿瘤位置，从视交叉前间隙、视神经外侧间隙和颈内动脉外侧间隙切除肿瘤，术中注意保护下丘脑神经结构和防止穿通动脉的损伤。结果 16例患者达到肿瘤全切除，8例次全切除，4例大部切除。术中垂体柄保留13例，断裂9例，未见垂体柄6例。术后14例患者有多饮多尿，11例3个月内恢复，3例持续一年以上；8例患者有血钠紊乱，6例在3周内恢复；3例术后视力障碍加重；4例手术对侧肢体瘫痪2周以上；死亡3例。术后随访3－15个月，14例术后能参加日常工作，6例生活自理，5例生活需要照顾。结论 选择合适的手术入路，保护下丘脑结构和功能，防穿通动脉的损伤，是大型垂体腺瘤全切除并获得良好效果的关键。

Microsurgical treatment of large and huge pituitary adenomas thr ough cranial cavity

Objectives: To study the effective method for treatment of large and huge pituitary adenomas.Methods: 28 patients with pituitary adenoma were operated on. Of the 28 patients, 19 were male and 9 were female, with age ranging form 24 to 48 years (mean 36 years). Pterional approache was performed in 19 patients; bilateral subfontal approaches in 6, and enlarg pterional approache in 3. The perforating arteries form the carotid, posterior and anterior communicating and anterior choroidal arteries to the hypothalamic structures were preserved when the tumors were excised by pterional approaches via the parachiasmal opticocarotid, carotidotentorial spaces and by opening the lamina terminals. Results: Of the 28 patients, 16 had a total removal of tumor, 8 a subtotal removal of tumor, and 4 a partial removal of tumor. The pituitary stalk was preserved in 13 patients, ruptured in 9, and unidentified in 6. In 14 patients with diabete insipidus after surgery, 11 patients recovered 3 months after surgery and 3 patients failed to over one year after surgery. 8 patients had normal blood sodium level 3 months after surgery. Three patients had decreased visual acuity. Four patients had temporal paralysis of the extremities after surgery. All the patients after surgery were followed up for 3 to 15 months. Three patients died after surgery. Conclusions: The proper surgical approaches for the removal of pituitary adenomas are the key to achieve good surgical result and avoid the injury to the hypothalamic structures and the perforating arteries to hypothalamus.