CT神经导航在经鼻蝶垂体瘤手术中的应用

Endo-nasal trans-sphenoidal approach in removal of pituitary adenomas under CT-based neuro-navigation

目的探讨神经导航系统在经蝶垂体瘤手术中的应用。方法62例患者术前行CT2mm薄层扫描,术中应用导航定位,指导手术操作。结果本组62例,42例行全切除术,19例行次全切除术,1例行部分切除术。无手术死亡,无术后出血及脑膜炎发生,无鼻中隔穿孔。术后52例得到随访,随访2个月～2年,无复发。术前视力、视野障碍患者36例,术后改善33例,3例术前失明患者术后视力无恢复;术前月经紊乱和闭经患者6例,术后恢复正常4例;术前泌乳素高患者6例,术后恢复正常4例;生长激素增高患者6例,术后均恢复正常。术后发生脑脊液漏2例,一过性尿崩2例,电解质紊乱4例,经治疗均恢复正常。4例出现垂体功能低下,需长期激素替代治疗。结论CT神经导航在经蝶垂体瘤手术中定位准确,安全性高,利于提高肿瘤全切率,减少手术并发症。

Objective To explore the application of neuron-avigation in the removal of pituitary adenomas by the endo- nasal trans-sphenoidal approach. Methods 62 patients with pituitary adenomas had 2 mm CT scans before surgery. All the operative procedures were done under the guidance of navigation. Results Among the 62 patients, total resection was achieved in 42 patients, subtotal in 19, and partial in 1 There were no deaths, rehaemorrhagia, meningitis, and perforated nasal septum. After a follow-up of 2 months to 2 years in 52 patients, no recurrence was found. Of 36 pa- tients with visual loss, 33 patients had postoperative improvement. There was no improvement in 3 patients with acroisa before the operation. Of 7 patients with menstrual disorder or amenorrhea, 4 patients had improvement. Of 6 patients with high PRL, 4 patients returned to a normal hormone level. 11 6 patients with high GH returned to a normal hormone level. CSF leakage was found in 2 patients, temporary diabetes insipidus was found in 2 patients, electrolyte disturbance was found in 4 patients, and all patients recovered after treatments. Hypopituitarism was found in 4 patients and needed to be treated with hormones for a long time. Conclusion CT-based neuro-navigation in the removal of pituitary adeno- mas by endonasal trans-sphenoidal approach is helpful in improving accuracy and reliability, raising the tumor removal rate and reducing surgical complications.