翼点入路显微切除侵袭型垂体腺瘤

Microsurgical Techniques of Removal of Invasive Pituitary Adenomas through Pterional Approach

目的 总结经颅翼点人路显微切除侵袭型垂体腺瘤的经验,争取尽可能对肿瘤全切,减少并发症。方法2000年至2004年采用Yasargil翼点入路在显微镜下切除侵袭型垂体腺瘤57例,全部属于Hardy分级Ⅲ级以上的侵袭型垂体腺瘤,术中注意充分利用鞍区周围的各个自然解剖间隙,应用良好的显微技术切除向各个方向侵袭生长的肿瘤。结果 全组病例无死亡,无与手术相关的新的神经功能障碍,获得显微镜下全切49例,占86％,次全切8例。结论 型垂体腺瘤的显微手术在绝大多数情况下可以经翼点入路完成,熟练掌握规范的手术入路和局部显微解剖以及良好的显微外科技巧是保证手术疗效的根本。

Objective To summarize the experiences in microsurgically treating invasive pituitary adenoma in order to remove the adenoma as totally as possible via the pterional approach and to reduce the operative complications. Methods Fifty-seven patients with invasive pituitary adenoma, which were grade Ⅲ or above according to Hardy classification, were treated by microsugical operation via Yasargil pterinoal approach from 2000 to 2004. All the natural anatomical gaps and good microsurgical technique were fully used during the operation for the invasive pituitary adenomas. Results No patients died from the operation and there were no comphcations relative to the microsurgical operation. Of 57 cases of the invasive pituitary adenomas, 49 were totally removed (86%) and 8 subtotally. Conclusions Most of the invasive pituitary adenomas may be totally removed by the pterional approach. Mastering the standard surgical approach, understanding the local microanatomy relative to the operation and the good microsurgical technique are the key to a good outcome of operation in the patients with invasive pituitary adenoma.