侵袭性垂体腺瘤术中垂体柄和下丘脑的保护和处理

Protection and Treatment of the Pituitary Stalk and Hypothalamus during Microsurgery for Invasive Pituitary Tumors

目的介绍经颅切除侵袭性垂体腺瘤的显微操作技术与经验。方法采用显微神经外科技术治疗侵袭性垂体瘤患者47例,并对肿瘤与垂体柄和下丘脑的关系及处理进行前瞻性研究。结果肿瘤全切除28例,近全切除12例,大部分切除7例。术中发现垂体柄并得到保护36例,术后发生下丘脑损伤表现22例。无手术死亡。术后随访二年无肿瘤复发。结论术前选择适当的手术入路,术中仔细辨认和正确处理肿瘤与垂体柄和下丘脑的关系,可有效保护下丘脑-垂体系统。

Objectives To investigate the microsurgical technique and to summarize the experience in treating invasive pituitary tumors, Methods A series of 47 patients with invasive pituitary tumors were treated by microsurgical techniques and the relationships of the pituitary, tumor with pituitary stalk and hypothalamus were analyzed prospectively. Appropriate surgical approaches were selected preoperatively according to the lesions sizes and expanding directions. The relationships of the lesions to the pituitary stalks and hypothalamus were carefully identified and the perforating vessels were protected. Results Total resection of the tumors was achieved in 28 cases, subtotal resection in 12 cases and part resection in 7 cases. The pituitary stalks involved by the pituitary tumors were identified and protected in 36 cases. There was clinical manifestation of hypothalamus injury in 22 patients. No patients died from the surgery. There was no recurrence of the tumors in all the patients during following-up for 2 years. Conclusions The selection of appropriate surgical approaches before surgery and careful identification of the relationships of the tumors with pituitary stalks and hypothalamus during the surgery are the keys to protecting the pituitary stalk and hypothalamus from the surgical injury in patients with invasive pituitary adenomas.