CT仿真内镜在内镜经鼻蝶窦垂体瘤手术中的应用

Application of computed tomography virtual endoscopy in endoscopic transsphenoidal pituitary surgery

目的探讨CT仿真内镜（CTVE）技术在神经内镜经鼻蝶窦垂体腺瘤手术中的应用价值。方法自2010年9月至2011年6月，应用神经内镜行经鼻蝶窦垂体瘤切除术38例，患者术前均行蝶鞍区320排CT容积扫描，进行CT仿真内镜图像重建，将术前CTVE和术中神经内镜图像进行比较，分析两者在该手术入路过程中的相关性及吻合度。结果CTVE可于术前模拟神经内镜经鼻蝶窦垂体瘤手术，显示手术入路过程中各个解剖结构。CTVE能于术前很好显示鼻腔、蝶窦、鞍底及周围解剖标志的三维图像，与术中内镜图像非常相似，解剖结构的吻合度良好，而蝶窦的大小、气化程度和分隔情况是影响CTVE图像的重要因素。结论CTVE不仅可以成为内镜垂体瘤手术的训练工具，而且能够在术前直观地显示患者手术入路过程中个性化的解剖结构及变异，指导术前计划、提高手术操作的安全性。

Objective To valuate the application of computed tomography virtual endoscopy （CTVE） for endoscopic transsphenoidal pituitary surgery. Method The CTVE was applied to a series of 38 patients with pituitary adenomas operated endoscopically via the transsphenoidal approach at the Wnxi Second Hospital Affiliated Nanjing Medical University between September ：2010 and June 2011. Results CTVE can be applied to simulate the endoscopic endonasal transsphenoidal pituitary surgery, and indicate the anantomic structure through the endonasal transsphenoidal approach. CTVE can preoperatively assess the morphological images of the nasal, sphenoid sinus, sellar floor and around structure, which correlated well with the intraoperative endoscopic view. The degree of pneumatization of the sphenoid sinus, the size of the sella and the sept conditions may influence the application of CTVE. Conclusions CTVE can not only act as a training simulator for the endoscopic transsphenoidal pituitary surgery, but for the experienced surgeon,it can depict the individual patient＇s anatomical landmarks and variations, what may help make preoperative planning and increase the safety of the endoscopic endonasal transsphenoidal pituitary surgery.