神经导航引导内镜下手术切除蝶窦发育不良的垂体腺瘤——附22例临床报告

Resecting Pituitary Adenoma through Sphenoidal Sinus of Underdevelop-ment by Neuronavigation Guided Endonasal Endoscopy

目的: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22例,其中泌乳素腺瘤15例,生长激素腺瘤2例,无功能腺瘤5例。结果:神经内镜和神经导航下全切肿瘤146例,近全切4例,大部分切除12例,术后13例内分泌化验恢复正常,其中18例术前有视力损害者,术后15例较术前好转,3例无变化;1例病人出现一过性脑脊液漏。22例病人随访3个月～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。

Objective：To discuss the value and significance of the techinique of endoscopic neuronavigation guided endonasal trans--sphenoidal of underdevelopment excision in pituitary adenoma operation. Methods：We performed endoscopic, endonasal resection of pituitary adenoma in 22 patients, including 15 cases of prolactinoma, 1 case of growth hormones secreting pituitary adenoma, and 5 cases of nonsecreting pituitary adenoma. Results： Total resection, subtotal resection and resection of bulk were performed on 16,4 patients and 2 patients, respectively. Recovery of normal hormone level after surgery was found in 15 pa- tients. Improvement of eyesight was found in 15 patients among 18 patients who had inpairment of visi6n before surgery,the rest were no change. Transient cerebrospinal rhinorrhea were found in 1 case. After a follow--up of 22 patients for 3--11 months, no recurrence, no perforated nasal septum and no atrophic rhinitis were found. Conclusion： Neuronavigation guided endoscopic transendonasal trans--sphenoidal of underdevelopment excision in pituitary adenoma resection has mang advantages,such as the excellent visualization, minimal nasal injury and decrease of postoperative complications and convenient operation and a shortened postoperative stay. The navigation system is quite accurate in delineating the location of the sella floor and midline, avoiding inter- ference of sphenoidal sinus of multi--room. Navigation systems could be very helpful to provide good bony detail for the approach and excellent resolution of soft tissue during the extirpation of the tumor and decrease the side injury during surgery. The combi- nation of neuronavigation and endoscope could increase the rate of toal resection and reduce recurring,which is ideal technique of minimally invasive surgery for the removal of pituitary adenoma through dysplastic sphenoidal sinus.