神经内镜在经鼻蝶入路垂体腺瘤显微手术中的应用

Neuroendoscope-assisted Microsurgery for the Resection of Pituitary Adenomas through Transnasal-sphenoidal Approach

目的探讨神经内镜在鼻蝶入路垂体腺瘤切除术中的应用价值。方法对经鼻蝶入路垂体腺瘤手术中应用神经内镜的30例病人的资料进行回顾性分析,并进行随访观察。结果神经内镜辅助下30例垂体腺瘤均全切。术后8例出现一过性尿量增多,4例病人出现尿崩,经对症处理治愈;无脑脊液漏及颅内感染发生。神经内镜可清晰地观察蝶窦内结构及分隔情况、鞍底及周围重要结构(海绵窦、颈内动脉隆凸及斜坡等),并了解肿瘤的切除程度。结论经鼻蝶垂体腺瘤切除术中应用神经内镜有助于术中辨认鞍底及周围重要结构,保持正确的中线手术操作方向,避免损伤重要结构,提高肿瘤的切除程度及减少手术并发症。

Objective To evaluate the effectiveness of neuroendoscope-assisted microsurgery for the resection of pituitary adenomas through transnasal-sphenoidal approach. Method The clinical data of 30 patients with pituitary adenomas, who underwent neuroendoscope-assisted microsurgery for resection of the tumors through transnasal-sphenoidal approach, were analyzed retrospec-tively. Results The tumors were totally resected in all the 30 patients with pituitary adenomas. Eight patients developed polyuria and 4 had transient diabetes insipidus after the operation. All the patients with diabetes insipidus were cured within 1 to 2 weeks. There were not cerebrospinal fluid leakage, intracranial infection and death.The structure and information of separation in sphenoidal sinus, sellar base and other important perisellar structurer, such as cavernous sinus, prominence of carotid artery and cliivus could cearly be observed through a neuroendoscope, and the degree of resection of the tumors could also be judged by it. Conclusions The correct operative direction can be acquired by a neuroendoscope. The advantages of the neuroendoscope-assisted microsurgery include a good visualization, avoiding injury to important perisellar structures, a high degree of resecting tumor and fewer surgical complications.