神经内镜辅助经单鼻孔-蝶窦切除垂体肿瘤

Neuroendoscope-assisted endonasal-transsphenoidal surgery for pituitary neoplasms

目的探讨采用经单鼻孔蝶窦路径、神经内镜辅助摘除垂体肿瘤(PNs)的手术技术并评价其疗效。方法将2003年12月至2004年9月入住本科的连续78例PNs患者行磁共振成像(MRI)或CT扫描检查,显示鞍区肿瘤并压迫视神经与视交叉。均采用经单鼻孔蝶窦路径、在神经内镜辅助下摘除PNs。结果71例患者(91.0%)肿瘤获全摘除,5例(6.4%)达次全切除,余2例(2.6%)纤维性肿瘤仅获部分切除。本组术后无死亡。对67例进行平均3个月的随访,64例(95.5%)视力迅速恢复,余3例(4.5%)亦有好转;术前有视野缺损的62例,术后60例(96.8%)恢复,另2例(3.2%)有改善。结论经单鼻孔蝶窦路径在神经内镜下切除PNs,是一种有效的微侵袭手术方法,术中将内镜变换角度,有助于安全而彻底地切除肿瘤。

Objective To evaluate the effect of curative effect of endonasal transsphenoidal approach for removal of pituitary neoplasms (PNs) assisted by neuroendoscopy.Methods Seventy-eight consecutive PNs patients with sellar mass causing compression of optic nerve and optic chiasm shown by MRI or CT underwent tumor removal via the endonasal transsphenoidal approach with the help of neuroendoscope.Results Total removal of tumor in 71 cases (91.0%) and subtotal removal in 5 cases (6.4%) were achieved. Partial removal was carried out in the remaining 2 cases (2.6%) with fibrous tumor. There was no postoperative death. Follow-up with a median of 3 months in 67 patients revealed that preoperative diminished acuity caused by optic nerve compression was recovered in 64 cases (95.5%), and improved in 3 cases (4.5%). Among the 62 patients with preoperative visual field defects, postoperative recovery was achieved in 60 cases (96.8%), and improvement in 2 cases (3.2%). Conclusion Endonasal transsphenoidal approach assisted by neuroendoscopy is an effective minimally invasive method for removing the PNs. Changing the angle of the endoscope intraoperatively helps removing the tumor safely and completely.