神经导航下经单鼻腔蝶窦入路垂体腺瘤切除术

Endonasal transsphenoidal approach to resect pituitary adenomas under neuronavigation

目的:探讨神经导航系统在经单鼻腔蝶窦入路切除垂体腺瘤的应用。方法:9例患者术前行核磁共振连续薄层扫描,将影像学资料输入神经导航系统,将颈内动脉、视神经、海绵窦、正常垂体、脑干和下丘脑等重要结构及肿瘤标记后行三维重建,设计出最佳手术入路,术中在导航棒的引导下准确定位并确定肿瘤的切除范围。结果:所有患者均在神经导航引导下经鼻蝶入路顺利到达肿瘤部位,平均误差为0.9mm。9例患者中肿瘤全部切除7例,次全切除2例,术后7例患者症状有不同程度的改善,2例无变化,术后无严重并发症。结论:导航引导下经鼻蝶手术与常规经鼻蝶手术相比,具有定位准确、简捷、安全、出血少及并发症少等优点。

Objective:To explore the application of neuronavigation in the resection of pituitary adenomas by endonasal transsphenoidal approach.Method:Nine patients with pituitary adenomas accepted continuous and thin slice MRI scans before surgery and the MRI data were transported to the neuronavigation system.The internal carotid artery,optic nerve,cavernous sinus,brain stem,hypothalamus and pituitary adenoma were marked and reconstructed in three dimensions,and on this basis the best approach to the adenoma was designed.Results:The tumor site was reached smoothly and accurately under the neuronavigation by transsphenoidal approach,the mean margin of error being0.9mm.Complete resection was achieved in7patients and subtotal resection was achieved in2.After operation,the symptoms were relieved in7cases and2patients showed no improvement.No severe complications developed after surgery.Conclusions:The application of neuronavigation in the endonasal transsphenoidal approach is helpful to improve the accuracy,decrease bleeding during surgery and reduce complications after surgery.