扩大额下硬膜内入路显微手术切除巨大垂体腺瘤术中垂体柄和垂体的保护

Preserving pituitary stalk and pituitary in microsurgical removal of giant pituitary adenoma via extended subfrontal introdural approach

目的 总结巨大型垂体腺瘤手术中对垂体柄及垂体的辨识和保护。方法 自 1998年 4月～ 2 0 0 2年 10月 ,采用扩大额下硬膜内入路显微手术治疗 76例巨大型垂体腺瘤 ,术中仔细辨识垂体柄及垂体并予保留。结果 肿瘤全切 6 3例 (83% ) ,5 4例 (71% )垂体柄及垂体得到辨认和保留。术后尿崩发生率为 6 1% ,39例 (5 1% )出现血钠紊乱 ,大部分在1周内恢复。功能性腺瘤术后激素水平明显下降或恢复正常。结论 扩大额下硬膜内入路可提高巨大垂体腺瘤的全切率 ,有利于术中辨识和保留垂体柄及垂体 ,对垂体柄位置、形态及肿瘤的切除范围的认识和理解 ,仔细耐心的手术操作是提高垂体柄及垂体保留率的关键。

Objective To study the identification and preservation of pituitary stalk and pituitary in the procedure of microsurgical removal of giant pituitary adenoma. Methods A series of 76 cases of giant pituitary adenomas was microsurgically treated by extended subfrontal introdural approach between April 1998 and October 2001, with great efforts in identifying and preserving the stalk. Results Total resection was adopted in 63 cases (83%), the stalk was preserved in 54 cases (71%). Postoperative course revealed remarkable decline of pituitary hormone in functional adenomas. Diabetes insipidus and blood sodium disorder were seen in 42 cases(55%) and 39 cases(51%), respectively, followed by a recovery in 1 week in most cases. Conclusion Extended subfrontal introdural approach plays a great role in microsurgical removal of giant pituitary adenoma, and facilitates preserving the pituitary stalk. A full understanding of the location, modality of the stalk, and the relationship between the stalk and tumor, are the key points in identifying and preserving the stalk and pituitary.