神经导航引导内镜下手术切除蝶窦发育不良垂体腺瘤——附19例临床报告

Resection of Pituitary Adenoma in Patients with Sphenoid Sinus Hypoplasia through Endoscopy with Neuroavigation System Guidance:Report of 19 Cases

背景与目的:经蝶窦入路切除垂体瘤是当今垂体瘤手术治疗的发展方向。本研究探讨应用神经内镜技术和神经导航技术在单鼻孔手术切除蝶窦发育不良型垂体腺瘤的意义与价值。方法:在神经导航引导内镜下经单鼻孔微创手术治疗垂体瘤19例,其中泌乳素腺瘤13例,生长激素腺瘤1例,无功能腺瘤5例。结果:神经内镜和神经导航下全切肿瘤14例,近全切4例,大部分切除1例,术后13例内分泌化验恢复正常,其中15例术前有视力损害者,术后13例较术前好转,2例无变化;1例出现一过性脑脊液漏。19例随访3～11个月,未发现复发。无鼻中隔穿孔、萎缩性鼻炎等并发症。结论:神经导航引导内镜下经单鼻孔手术切除蝶窦发育不良型垂体腺瘤具有深部照明好,鼻腔结构损伤小、操作简捷、术后恢复快等优点,神经导航技术的应用可以避免蝶窦多房分隔的干扰,快速确定鞍底位置、判定肿瘤切除的程度与范围、减少手术对肿瘤周围神经血管结构的副损伤,二者结合能提高手术全切率,减少复发,是蝶窦发育不良型垂体腺瘤微创外科治疗的理想手段。

BACKGROUND ＆ OBJECTIVE： To assess the value of neuronavigation system guided endoscopic resection of pituitary adenoma in patients with sphenoid sinus hypoplasia. METHODS： We performed endonasal endoscopic reseclion of piluilary adenoma in 19 palienls, including 13 cases of prolaclinomas, 1 case of growth hormone-secreting pituitary adenoma, and 5 cases of nonfunctional pituitary adenomas. RESULTS： Of 19 patients, total removal was achieved in 14 cases, subtotal removal in 4 cases and partial removal in 1 case. Thirteen patients recovered to normal endocrine function postoperatively. Among 15 patients with pre-operative visual impairment, 13 cases improved and 2 cases remained stable. One patient had transient cerebrospinal fluid leakage. After a follow-up of 3 toll months, no recurrence and complication including petforated nasal septum and atrophic rhinitis were found. CONCLUSION：Neuronavigation system guided endoscopic transendonasal transsphenoidal excision of pituitary adenoma resection in patients with sphenoid sinus hypoplasia is a safe and effective.approach, with the advantage of excellent visualization, accurate localization, minimal nasal injury and low rate of postoperative complications.