巨大型垂体腺瘤的显微外科手术治疗

Microsurgery for Giant Pituitary Adenoma

目的探讨扩大前颅底经纵裂经平台蝶窦入路手术治疗巨大垂体腺瘤的疗效。方法1999年12月～2004年12月,对21例巨大型垂体腺瘤采用扩大前颅底经纵裂经平台蝶窦入路进行显微外科手术治疗,术前均经MRI检查,肿瘤最长径平均4.8(4.0～7.5)cm。结果肿瘤全切除18例(85.7%),次全切除3例(14.3%),无手术死亡病例。术后患者症状均有所改善,但发生脑脊液漏1例,短时尿崩4例,2例未能保留嗅神经,1例仅保留1侧。术后平均随访2.5(0.5～5.5)年,复查内分泌检查、MRI未见复发。结论此入路视野广阔、暴露良好、无严重并发症,可提高巨大垂体腺瘤的手术效果。

Objective To investigate the extended translongitudinal fissure and sphenoidal platform sinus approach in the surgical treatment of giant pituitary adenoma. Methods 21 patients with giant pituitary tumours underwent microsurgery via extended translongitudinal fissure and sphenoidal platform sinus approach, preoperative MRI revealed the longest diametre of tumor was 4.0 to 7.5 cm （ mean 4.8 cm）. Results The tumor was completely resected in 18 patients and subtotally resected in 3 patients. No occurence of intraoperarive death. Symptomatic remission acheived in all cases, whereas complicated spinal cerebral fluid leakage in 1 case, short-term diabetes insipidus in 4 cases. Bilateral and unilateral olfactory nerve resection performed in 2 cases and 1 case respectively. There was no recurrence as followed with MRI and blood test for 0.5 to 5.5 year （mean 2.5 years）. Conclusion The extended translongitudinal fissure and sphenoidal platform sinus approach can achieve more satisfied operative field without severe complications, resulting in improved surgical outcome of giant pituitary adenoma.