内镜下经蝶窦入路垂体瘤切除术中影像导航的应用

Application of navigation assisted endoscopic transsphenoidal removal of the pituitary adenomas

目的:探讨无框架影像导航系统在内镜下经蝶窦入路垂体瘤切除术中的应用。方法:10例患者在美国Medtronic Sofamor Danek公司Stealth Station TREON红外线无框架影像导航系统下行内窥镜经蝶窦入路垂体瘤切除术。大腺瘤2例,微腺瘤8例,其中2例为复发患者。结果:影像导航定位误差1.5±0.37mm,定位蝶窦、鞍底、视神经管突、颈内动脉管隆凸、腺瘤的位置准确率为100%。影像导航系统准备及配准时间平均为15min,手术时间平均为50min。术后除3例出现一过性尿崩外,未出现垂体前叶功能下降、脑脊液漏、颈内动脉损伤、下视丘损伤、视神经损伤和脑膜炎等并发症。结论:影像导航系统在内镜下经蝶窦入路垂体瘤切除术中对重要结构和病变部位定位准确,可发挥重要作用;特别是在再次手术中,由于前次手术造成的蝶窦前壁和鞍底结构不清,蝶窦内呈纤维骨化,很难准确判断鞍底,在导航的指引下,可迅速定位瘤体所在鞍底位置。

Objective：To explore the application of frameless image-guidance system in endoscopic transsphenoidal removal of pituitary adenomas.Methods：Ten patients were performed endoscopic transsphenoidal removal of pituitary adenomas guided by Stealth Station TREON frameless infrared imaging system,which is the product of Medtronic Sofamor Danek company in the United States.Two out of the 10 were patients of macro-adenomas, eight were micro-adenomas, two were patients with recurrence.Results：The error of image-guided positioning was 1.5±0.37mm.The accuracy of positioning the sphenoid sinus,base of saddle,optic canal process,the internal carotid artery of the carina, and adenoma was 100%.The average time for the preparation and registration of image-guided system was 15 minutes,the average operation time was 50 minutes.There were no complications after operations such as decline of anterior pituitary function,cerebrospinal fluid leakage,internal carotid artery injury,hypothalamic injury,optic nerve damage or meningitis,except that three patients had diabetes insipidus onset after the operation.Conclusion：Image-guidance system plays an important role in localizing the key structures and affected parts in endoscopic transsphenoidal removal of pituitary adenomas.Especially in the second operation,it is difficult to locate the anterior wall of sphenoid sinus and the base of saddle due to the foregoing operation had left these structures unclear and fibero ossification inside of sphenoid sinus. However,they can be rapidly located through image guidance.