神经内镜下经鼻蝶手术治疗鞍区及斜坡肿瘤

Neuroendoscopic endonasal transsphenoidal approach for sellar and clivus neoplasma

目的探讨神经内镜下经鼻蝶手术入路治疗鞍区垂体瘤及斜坡肿瘤的手术适应证、手术方法、技巧及优缺点。方法总结神经内镜下经鼻蝶入路治疗垂体瘤27例、斜坡肿瘤3例(脊索瘤2例、鼻咽癌1例)的临床资料,全部病例术前均行CT/MRI扫描及内分泌检查。结果肿瘤全切21例,次全切除6例,大部分切除3例;随访2年复发3例;并发症:尿崩11例,脑脊液漏4例,蛛网膜下腔出血1例;死亡1例。结论神经内镜下经鼻蝶手术入路治疗鞍区及斜坡肿瘤与传统手术比较,具有创伤较小、视野清晰、切除范围较广、并发症较少等优点,可能成为今后垂体瘤及斜坡肿瘤手术治疗的发展方向。

Objective To determine the indications,approaches,techniques , advantages and disadvantages of Endoscopic endonasal transsphenoidal approach for pituitary sellar adenomas and clivus neoplasm. Methods The clininical data of 27 pituitary adenomas and 3 clivus tumors （2 chordoma and 1 nasopharyngeal carcinoma） with endoscopic trans-single nose transsphenoidal approach were reviewed retrospectively. All patients received neuroimaging （ CT and MRI ） and endocrinological examinations before the surgery. Results The tumors were totally reseeted in 21 patients,subtotally resected in 6,and partially reseeted in 3. There were 3 tumors relapsed in the 2 year follow-up. The complications included ：11 patients with diabetes,4 with cerebrospinal fluid leakage and 1 with subarachnoid hemorrage. And one patient was died. Conclusions The endoscopic endonasal transsphenoidal approach for sellar and clivus lesions appears to have less traumatic lesions, clearer field of vision, easier to achieve complete resection of tumors and less complications than the traditional microsurgieal approach. It is possible to be the future surgical treatment for sellar and clivus neoplasma.