神经导航在经单鼻孔入路垂体腺瘤切除术的应用

Application of Neuronavigator System in Endonasal-Transsphenoidal Approach for Removal of Pituitary Adenoma

目的探讨神经导航系统在经单鼻孔入路垂体腺瘤切除术中的应用技术及对鞍区解剖结构识别的价值。方法对39例垂体腺瘤使用StealthStation神经导航系统进行指导定位、识别入路相关的解剖结构并引导手术操作。结果平均注册误差为2.3mm(1.6～3.3mm),肿瘤全切除32例,次全切除4例,大部切除2例,部分切除1例。未全切除病例主要是肿瘤巨大、向海绵窦侵袭性生长、质地坚硬或血供异常丰富者。结论神经导航系统提供了准确可靠的定位,能够准确指示中线结构、鞍底和颈内动脉,有效地减轻了创伤,使之成为良好的手术辅助工具。

Objective To study the technique of neuronavigation system in direct endonasal approach for resection of pituitary adenomas. Methods 39 eases of pituitary adenoma were underwent endonasal- transsphenoidal surgery. SteahhStation neuronavigation system was employed to confirm the orientation, localize the anatomic landmarks and guide the approach during operations. Results Mean inscription error was 2.3 mm, ranged from 1.6 mm to 3.3 mm. Total removal of adenoma was achieved in 32 eases, subtotal removal was achieved in 4 cases, mostly removal was achieved in 2 eases and partial removal was achieved in 1 ease. Huge tumor, invading cavernous sinus, hardness or excessive abundant vaseularity were responsible for the difficulty of total removal in few cases. Conclusion The neuronavigation system provided exact and reliable localization. The midline structures, sellar floor and internal carotid artery can be identified exactly with the guidance of this system. It is much helpful to reduce surgical trauma, so it has become an effective assistant tool in endonasal-transsphenoidal surgery.