神经导航引导下内镜经蝶入路切除鞍上型巨大垂体瘤

目的：探讨神经内镜及神经导航用于经鼻蝶入路治疗鞍区肿瘤的临床应用及手术技巧.方法：2007-03～2013-11,应用神经内窥镜结合神经导航技术经鼻蝶手术切除鞍上型巨大垂体肿瘤32例.结果：肿瘤全切除24倒,近全切除6倒,大部分切除2例.术后所有患者症状均有不同程度改善.术后有2例患者出现一过性脑脊液漏;术后5例出现尿崩症,其中1例需长期口服弥凝.无严重并发症发生.结论：内镜技术经鼻蝶手术治疗垂体肿瘤,具有对鼻腔正常结构损伤小、暴露清楚等特点,特别是对于传统显微镜手术不能暴露的鞍上结构显露满意.结合导航技术能提高肿瘤的全切率及手术的安全性。

Image-guided endoscopic transnasal transsphenoidal approach for the treatment of suprasellar giant pituitary adenomas

Objective： To discuss the clinical application and the technique of endocope and neuronavigation in transnasal transsphenoidal approach for the treatment of suprasellar giant pituitary adenomas. Methods： From Mar. 2007 to Nov. 2013, 32 patients were underwent Image--guided endocopic transnasal transsphenoidal approach surgery for pituitary adenomas. Results： The tumor was totally removed in 24 cases, subtotally removed in 6 cases, and partially removed in Z cases. All patients obtained an improvement in clinical symptoms at some extent after the operation. After operation, transient cerebrospinal fluid leakage occurred in 2 cases, transient diabetes insipidus occurred in 5 cases, 1 case developed diabetes insipidus. None of the patients were suffered from permanent complications. Conclusion： The advantages of endoscopic transnasal transsphenoidal approach for the treatment of the tumor in the sellar region are minimal injury to nasal cavity, and provision of a wide view, especailly in the suprasellar region which can not be directly ivsualized under the tradiontional microcopic surgery. Combined with image--guided technique , the safty of the surgery and the rate of total tumor remove were improved.