神经内窥镜下单鼻孔经蝶入路切除垂体腺瘤

The surgical treatment of pituitary adenoma by neuroendoscopic unilateral endonasal transsphenoid

目的探讨神经内窥镜下单鼻孔经蝶入路切除垂体腺瘤的方法。方法25例垂体腺瘤患者,在神经内窥镜下经单鼻孔进入,不切除骨性鼻中隔,直接自蝶窦开口打开蝶窦前壁,进一步经鞍底切除垂体腺瘤。结果25例患者中,17例肿瘤全切除,8例肿瘤次全切除;术后随访1-19个月,16例有视力下降和(或)视野缺损者,术后均有改善,11例患者内分泌功能恢复正常,3例术后发生暂时性尿崩症。结论神经内窥镜单鼻孔经蝶切除垂体腺瘤入路与常规经蝶显微手术比较,入路途径较短,视野更广,安全简捷,显露良好,值得推广。

Objective To investigate the possibility of unilateral endcoasal transsphenoidal pituitary adenoma resection under neuroendoscopy. Methods 25 patients with pituitary adenoma were treated by unilateral endcoasal transsphenoid under neuroendoscupy. During approach, dissection of the nasal septum and median nasal conches were not made, the anterior wall of the sphenoid sinus and seller base opened directly and adenoma resection performed. Results By postoperative MRI detection, adenomas in 17 patients were removed completely , but parts of the adencmas were left in 8 patients. All the patients were followed up for 1 - 19 months, among of the them 16 patients with decreasing of vision and/or defect of visual field were improved, and the increased hormone level in 11 patients were decreased to normal postoperatively . Temporary diabetes insipidus was observed in 3 patients. Conclusion Comparing with conventional transsphenoidal approach under mieroscopy , the unilateral endonasal transsphenoidal approach in pituitary adencma resection under neuroendoseopy is short route, wider visual field, safe, time saving and worth to extending.