翼点锁孔入路神经内镜辅助下垂体腺瘤显微手术策略

Neuroendoscope-assisted microsurgery in patients with pituitary adenoma via pterional keyhole approach

目的探讨翼点锁孔入路神经内镜辅助下垂体腺瘤显微手术策略。方法选择翼点锁孔概念，利用神经内镜的辅助技术，对33例鞍区的垂体腺瘤患者先行单纯显微镜辅助下手术切除，然后再联合神经内镜切除肿瘤，比较两种方法的全切率。结果33例患者中先用显微镜辅助下手术获得全切20例，次全切13例；13例次全切患者再联合神经内镜手术后获得全切8例．次全切5例。联合神经内镜手术获得全切的例数（28例）明显多于单纯显微镜手术（20例），差异有统计学意义（P〈0．05）。结论利用翼点锁孔入路，神经内镜辅助下行垂体腺瘤显微手术能够克服手术中的死角，提高手术切除率，减少肿瘤残余，保护垂体柄，减少并发症，大大提高手术的效果。

Objective To explore the role of neuroendoscopy in microsurgery in patients with pituitary adenoma via pterional keyhole approach. Methods Thirty-three patients with pituitary adenomas in the sellar region were performed microscope-assisted microsurgery and neuroendoscope-assisted microsurgery via pterional keyhole approach. The data of these patients and the total removal rate of these 2 strategies were analyzed and compared. Results Of the 33 patients, 20 achieved total removal of the pituitary adenoma with microscope-assisted microsurgcry via pterional keyhole approach and 13 got subtotal removal. Then, these 13 patients were performed neuroendoscope-assisted microsurgery via pterional keyhole approach： total removal was received in 8 and subtotal removal in 5. The total removal percentage that was got under the help of neuroendoscope-assisted microsurgery （28/33） was significantly higher as compared with that using microsurgery （20/33, P〈0.05）. Conclusion Neuroendoscopc-assisted microsurgery via pterional keyhole approach, being able to enlarge the visible field in the microsurgery in patients with pituitary adcnoma, increases the complete resection rate, protects the pituitary stalk and decreases the happening of complications.