大型、巨大型垂体腺瘤导致周围重要结构异常改变的观测

AN OBSERVATION OF ABNORMAL VARIATIONS OF IMPORTANT STRUCTURES SURROUNDING THE LARGE AND HUGE PITUITARY ADENORMAS

目的：探查大型、巨大型垂体腺瘤周围重要结构的变异情况。方法：在１９例垂体瘤病人进行显微手术切除术时，观察其变异情况。结果：１）视神经、视交叉全部被牵拉、受压、抬高，部分与肿瘤发生粘连。２）鞍膈全部向上隆起，在肿瘤上长出分叶的小肿瘤处鞍膈破溃。垂体柄被挤压在鞍膈的后下方。３）视交叉池不完整，在粘连及垂体柄进入鞍膈处，蛛网膜下腔已经消失；在肿瘤挤压（包括动脉）处，蛛网膜下腔仅为一潜在腔隙。４）凡被肿瘤挤压、包围、发生粘连的硬脑膜、神经及血管均有肿瘤新生血管形成。结论：大型、巨大型垂体腺瘤对周围重要结构产生挤压，发生粘连，部分蛛网膜下腔消失，并有肿瘤新生血管形成。以上异常与肿瘤大小及生长方向直接相关。了解上述规律。

Objective:To explore the abnormal variations of important structures surrounding the large and huge pituitary adenomas.Methods:Abnormal conditions during microsurgery on 19 patients with large and huge pituitary adenoma were observed. Results: 1)All optic nerves, and optic chiasmas were pushed,compressed and elevated.Adhesion occurred between some of the nerves and the tumor. 2)Diaphragm sella was pushed up by the tumor.The location of diaphragm sella where the small tumor grew up was damaged.The hypophyseal stalk was depressed down in the posteroinferior part of the diaphragm sella. 3)The chiasmatic cistern was not intact.At some parts of this cistern, the subarachnoid space disappeared.At other parts of this cistern,where the arteriae were compressed or surrounded by the tumor,there were crevices instead of cistern. 4)There were some new tumor vessels coming from meninges,nerves,and arteriae. Conclusion:Important structures surrounding the large and huge pituitary adenomas are compressed and adhered by the tumors.Some parts of the subarachnoid space disappear.Some new tumor vessels emerge from the surrounding structures.All the above conditions are related to the size and growing directions of tumors.Operation results may be improved if the abnormal variations are recognized and well handled.