多技术辅助神经内镜下侵袭海绵窦的垂体腺瘤的治疗

Treatment of Pituitary Adenomas Invading Cavernous Sinus with Neuroendoscopy Assisted by Multiple Techniques

目的探讨多技术辅助神经内镜下侵袭海绵窦的巨大垂体腺瘤的手术疗效。方法对比分析同期72例神经内镜下和55例显微镜下侵袭海绵窦的巨大垂体腺瘤的手术疗效,两组均采用扩大经蝶入路,术中应用神经导航和多普勒,并对两组临床资料进行统计学分析。结果神经内镜组与显微镜组在肿瘤全切率、手术时间、术后鼻腔通畅率和术后复发率方面差异具有统计学意义(P=0.004,P=0.0003,P=0.000,P=0.002);在脑脊液漏、术后尿崩、颅神经损伤等方面差异无统计学意义(P>0.05)。结论多技术辅助神经内镜下扩大经蝶入路是治疗侵袭海绵窦的巨大垂体腺瘤的首选手术方法,外侧海绵窦入路和分子生物学研究为侵袭性垂体腺瘤的治疗提供了更为广阔的前景。

Objective To study the effectiveness of treating giant pituitary adenomas invading cavernous sinus with neuroendoscopy assisted by multiple techniques. Methods A total of 72 patients who underwent neuroendoscopic surgery and 55 patients who underwent microscopic surgery for giant pituitary adenomas were enrolled in this retrospective analysis. Both groups received expanded endoscopic endonasal transsphenoidal approach, intraoperative application of navigation, and Doppler. The clinical data of two groups were compared. Results The two groups were significantly different in total tumor removal rate, operation time, postoperative nasal pateney, and postoperative recurrence rate （P = 0. 004, P = 0. 0003, P = 0. 000, and P = 0. 002, respectively）, whereas the cerebrospinal fluid leakage, postoperative diabetes insipidus, and cranial nerve injury were not significantly different （P 〉 0. 05 ） . Conclusions Expanded neuroendoscopic endonasal transsphenoidal approach assisted by multiple techniques is the preferred surgical method for giant invasive pituitary adenomas invading cavernous sinus. The lateral cavernous sinus approach and the further molecular biology research will bring more options for the treatment of invasive pituitary adenomas.