经颅与经蝶窦分期手术切除巨大垂体腺瘤

Removing giant pituitary adenoma by staging operation via the transcranial and the transsphenoidal sinus approach

目的探讨经颅入路与经蝶窦入路分期切除不同生长方式的巨大垂体腺瘤的手术方法及临床意义。方法回顾性分析我科行经颅与经蝶窦分期手术的12例巨大垂体腺瘤患者的临床表现、影像学特点,根据肿瘤的不同形态及生长方式,结合手术入路和手术方式探讨其手术疗效。结果本组病例根据生长方式的不同分为:①单纯向上呈葫芦形生长,经额下入路及经蝶窦入路手术者4例;②向鞍上及鞍旁生长,行经翼点入路及蝶窦入路手术者6例;③向三脑室及侧脑室生长,经侧脑室入路及经蝶窦入路手术者2例。二次手术间隔时间1～3月间不等,均采用显微手术治疗,其中肿瘤全切除8例,次全切除3例,大部切除1例,无死亡发生。结论手术前应根据病史和影像学资料判断肿瘤的形态、生长方式、所累及的解剖腔隙和重要结构,选择合理的分期手术方法,才能取得较好的临床治疗效果。

Objective To evaluate the operation methods and the clinical significance of staging operation removing giant pituitary adenoma in various forms through the trans - cranial approach and the transsphen0idal sinus approach. Methods To study the operation effects of different growing manner of the giant pituitary adenoma by analyzing the characteristics of the clinical histories,the imageological phenomena,and their operation therapeutic regimenin in view of 12 cases of the patients who had done operations through trans - cranial and transsphenoidal sinus approach. Results By different growing directions,all cases are classified as follows.4 cases growing only towards upper saddle area like a cucurbit were done through trans -subfront and the transsphenoidal sinus ;6 cases growing towards the upper saddle area and parasaddle were solved through transpterion approach and transsphenoidal sinus ;2 cases growing towards the third ventricle and lateral ventricle were solved via lateral ventricle and transsphenoidal sinus,and the interval time between the two operations changed from 1 to 3 months, 8 cases of them were removed completely,3 cases almost completely,and 1 case partially. No patient died in all cases. All cases were done under the operative microscope, Conclusions The suitable staged operation,which was based on clinical history and radiological data,the growth configuration of adenomas and involved anatomic lacunas, better clinical therapeutic results could be obtained and injury to the vital anatomy structures can be avoided.