经眉弓锁孔手术治疗垂体巨腺瘤

Clinical Studies on Eyebrow Keyhole Approach for Giant Pituitary Adenomas

背景与目的:垂体巨腺瘤的手术治疗疗效一直不令人满意,本研究探讨经眉弓锁孔手术切除垂体巨腺瘤的方法及疗效。方法:回顾性分析18例经眉弓锁孔手术切除的垂体巨腺瘤的临床资料和手术方法,部分病例术中采用神经内镜辅助观察。结果:术后复查MRI显示,垂体巨腺瘤全切15例,次全切3例,术后予γ-刀治疗。无手术死亡、颅内出血、感染等并发症。术后尿崩4例,数日至数月后恢复正常,视力下降2例。近期随访疗效良好。结论:眉弓锁孔手术可用于鞍区垂体巨腺瘤的手术切除,尤其适用于已向鞍周广泛生长为主的肿瘤,并具有手术路径短、操作简洁、微创、切除率满意、疗效佳等特点。内镜术中辅助观察可提高肿瘤全切率,减少神经血管结构的损伤。

BACKGROUND ＆ OBJECTIVE ： Surgical treatment for giant pituitary adenomas is still unsatisfactory yet. This study is to investigate the microsurgical methods and therapeutic effects of eyebrow keyhole approach for giant pituitary adenoma. METHODS： Eighteen patients with giant pituitary adenoma underwent surgery via an eyebrow keyhole approach were reviewed. Neuroendoscopy was performed during the operation in part of the surgical cases. RESULTS： Post-operative MR/ showed 15 giant pituitary adenomas were totally removed, while in 3 patients, the tumors were subtotally removed and they underwent γ-knife radiotherapy postoperatively. There was no approach-related death, hemorrhage, infection or other significant complications. Four patients suffered postoperative diabetes insipidus. They all recovered completely after several days to a couple of months. Visual activity of 2 patients decreased after surgery. These two patients showed visual recovery in recent follow up. CONCLUSIONS： Eyebrow keyhole approach was simple, convenient, and feasible for most of the giant pituitary adenoma, especially for those with suprasellar extension. Our data showed it was a minimally invasive surgery procedure with better curative effects. With the assistance of neuroendoscopy, surgeons were able to reduce tumor residual and decrease injuries on neurovascular structures.