神经导航辅助下经单鼻腔蝶窦入路切除垂体腺瘤

Resecting Pituitary Adenomas by Neuronavigator-assisted Microsurgery through Endonasal Transsphenoidal Approach

目的评价神经导航系统在经单鼻腔蝶窦人路垂体腺瘤切除手术中的应用。方法24例病人术前行MRI或CT连续薄层扫描,将影像学资料输入Brain LAB Vector Vision神经导航系统进行三维重建,标记出肿瘤及重要结构后,设计最佳手术入路,术中在导航的引导下定位蝶窦前壁、鞍底、海绵窦、颈内动脉和斜坡等结构,切除肿瘤。结果24例患者均在神经导航引导下经鼻蝶入路顺利到达肿瘤部位；注册误差0．3～2．0mm,平均(1．21±0．39)mm；肿瘤全切除19例,次全切除3例,大部分切除2例；术后19例病人症状有不同程度的改善,5例无变化,术后无严重并发症出现。结论神经导航辅助下经鼻蝶垂体腺瘤切除术具有定位准确、创伤小等优点．效果良好。

Objective To evaluate the application of neuronavigation system to the resection of pituitary adenomas through endonasal transsphenoidal approach. Methods All of 24 patients with pituitary adenomas accepted the continuous and thin slice MR[ or CT scans before the surgery and the MR[ or CT data was transported to the neuronavigation system. The internal carotid artery, optic nerves, cavernous sinus, brain stem, hypothalamus and pituitary adenoma were marked. Their imagings were reconstructed in three dimensions. The best approach was designed according to the above data. The above structures were precisely localized by tile navigation system and the tumors were resected under the monitoring of neuronavigator. Results The registration error ranged from 0.3 to 2.0mm （mean, 1.21mm＋0.39mm） in 24 patients. Of 24 patients with pituitary adenomas, 19 received total resection of the tumors, 3 subtotal and 2 greatly part, The postoperative symptoms were improved in 19 patients, and unchanged in 5. There were no severe postoperative complications in all the patients. Conclusions The application of neuronavigation to the endonasal transsphenoidal surgery is helpful to improving the accuracy of location and decreasing the injury to important intraeranial structures.