经颅锁孔及经鼻蝶入路治疗鞍区病变56例临床分析

The clinical application of keyhole approach and endonasal transsphenoidal approach to sellae region

目的:评价眉弓、翼点、颞下锁孔手术入路以及神经内镜下经鼻蝶入路的优劣。方法:对56例鞍区病变进行微创手术,其中垂体瘤26例,动脉瘤15例,脑膜瘤8例,蛛网膜囊肿5例,颅咽管瘤2例。分别采用不同入路进行手术。结果:所有垂体瘤患者全切除21例,近全切除4例,大部分切除1例;视力减退及视野缺损改善11/13例,异常增高的激素水平降至正常15/20例;随访2年MRI检查尚无一例复发。动脉瘤患者Hunt-Hess临床分级:Ⅰ级4例,Ⅱ级8例,夹闭后恢复满意,3例Ⅲ级病例中有1例术后发生迟发性脑血管痉挛,枕叶梗塞,另2例效果满意。8例脑膜瘤均做到Simpsom Ⅱ切除,视力明显改善,无并发症发生。蛛网膜囊肿大部分切除囊壁,效果满意。结论:神经内镜下的手术术野较显微镜更清晰,手术盲区少;但在处理主要向鞍上池、额叶及视交叉池扩展的垂体瘤时该入路有明显缺陷。巨大型主体在鞍上、分叶状或哑铃型向鞍旁、前中后颅窝生长的肿瘤仍以经颅锁孔手术为佳。根据鞍区病变部位不同而采取相应的微创手术入路可提高手术的全切率、降低致残率。

Objective：To exaluate the value of clinical application of microinvasive approach to sellae region. Methods：Using neuroendoscope and microscope,56 sellar region tumor cases accepted microinvasive operation. 43 cases were given keyhole approach,13 cases accepted endonasal transsphenoidal approach operation. Results：Total tumor resection was achieved in 21 cases,subtotal in 4, and partial in 1 case. The visual acuity were ameliorated in 11/13 cases,and the high level of hormones was decreased to normal degree in 15 / 20 cases. No case was found recurrence by MRI during 2 years follow-up. According to Hunt-Hess grade：4 cases ofⅠ grade and 8 cased of Ⅱgrade were cured by clipped the aneurysm,and cerebral angio spasm was found in one case of 3 of Ⅲ grade,and other two cases gained satisfied result. 8 case of meningeomas gained SimpsomⅡ resection,the visual acuity was ameliorated and no complications were found. Conclusion：It is available to decrease the morbility and improve the removal rate by corresponding mininvasive approaches according to different location of lesions.