大型垂体腺瘤经眉切口眶上锁孔入路显微切除的探讨

目的　总结和介绍经眉切口眶上锁孔入路 ,显微手术切除大型和巨型垂体腺瘤的临床体会。　方法　对经头颅CT及MRI检查确诊为大型和巨型垂体腺瘤的 44例 ,作一侧眉内长约 5cm的切口 ,眶上铣 2 5cm× 3 5cm半圆形的游离骨瓣 ,抬起额叶暴露鞍区 ,在手术显微镜下沿鞍膈和肿瘤包膜之间分离解剖肿瘤界限与肿瘤囊内分块切除交替进行 ,最终将肿瘤分离全切除。术后半年随访 ,进行头颅MRI检查 ,观察肿瘤切除情况 ,并检测血清激素水平和视力、视野 ,判断临床疗效。　结果　临床40例达到肿瘤全切除 ,2例近全切除 ,2例大部切除。术后原有临床症状均有明显改善 ,无死亡病例。　结论　采用经眉切口眶上锁孔入路 ,能够在手术显微镜下切除大型和巨型垂体腺瘤 ,而且损伤反应小 ,并发症少 ,康复快

Microsurgical resection of large pituitary adenomas via transeyebrow supraorbital keyhole approach

Objective To study the microsurgical excision of large and giant pituitary adenomas via transeyebrow supraorbital keyhole approach and discuss the advantages of this approach Methods Forty four patients were treated with microneurosurgery via transeyebrow supraorbital keyhole approach Transverse incision was made about 5 cm,include external two third of eyebrow The skull window was about 3 cm in diameter The operative space was between subdual and epiarachnoid Under the microscope,border of tumor and its capsule could be found and dissected step by step Tumor was removed piece by piece and could be removed totally The follow up survey after 6 month, includes MRI examination,endocrine changes,visual power and visual field Result Total excision of pituitary adenomas was achieved in 40 patients;2 patients subtotal excision,and large part was removed in another 2 patients There was no mortality in this group The clinical symptoms were improved in all patients Conclusion The transeyebrow supraorbital keyhole technique is a minimally invasive technique and can be used in excision of large and giant pituitary adenomas,it can reduce the operative injury and morbidity