经蝶入路显微手术治疗原发性空蝶鞍综合征(附16例报道)

Transsphenoidal microsurgical treatment of primary empty sellasyndrome

目的报道16例合并有各种症状和体征的原发性空蝶鞍综合征(primaryemptysellasyndrome,PESS)患者的手术治疗。方法16例病人均于术前经影像学检查确诊为PESS,经蝶入路于显微镜下行蝶鞍内—硬膜下脂肪、肌肉、筋膜等填塞、鞍底垫高术。结果手术消除了陷入鞍内的扩大的视交叉池,解除了鞍内脑脊液对垂体及其周围结构的搏动性压迫和侵蚀,其症状改善明显。结论经蝶入路显微手术治疗原发性空蝶鞍综合征是一种安全、疗效肯定的方法。同时对原发性空蝶鞍综合征的病因、形成机制、临床表现、诊断和手术适应证及治疗方法也进行了探讨。

Objective The surgical treatment of 16 cases of patients with primary empty sella syndrome （PESS） who presented with various symptoms and signs were reported. Methods 16 cases of PESS were diagnosed preoperatively by radiological examination. Intrasellar extradural plugging of the sellar cavity with fat,muscle and fascia via transsphenoidal approach were performed. Results The subarachnoid space herniated into the sellar cavity was obliterated, hence the pulsative compression and erosion of the intrasellar cerebrospinal fluid on the pituitary gland and the surrounding structure were relieved. The symptoms and signs of the patients were improved postoperatively. Conclusion Obliteration of PESS by transsphenoidal approach is a safe and effective therapeutic method. The etiology,pathogenesis,clinical manifestations, standards of diagnosis,operative indications and treatment methods of the PESS were also discussed.