神经导航下经蝶手术治疗激素分泌型垂体微腺瘤

Clinical Application of Neuronavigation in Transsphenoidal Microsurgery of Hormone-secreting Pituitary Microadenomas

目的总结神经导航下经蝶手术治疗激素分泌型垂体微腺瘤的经验和疗效。方法对59例神经导航下经蝶激素分泌型垂体微腺瘤手术病例进行回顾性分析。本组既往经蝶手术后复发性垂体微腺瘤7例,位于垂体侧方或深部的微腺瘤45例,颅底异常增厚3例,蝶窦气化不良1例,双侧颈内动脉间距狭窄3例。结果所有病例均成功完成手术,肿瘤全部切除57例,近全切除2例。术后出现一过性水、电解质紊乱31例,无死亡和永久性并发症。垂体泌乳素(prolactin,PRL)腺瘤2例均治愈。垂体生长激素(growth hormone,GH)腺瘤10例,治愈8例,进步1例,无效1例。促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)腺瘤47例,治愈39例,进步1例,无效7例;其中复发性促肾上腺皮质激素腺瘤7例,治愈6例,无效1例。结论神经导航可以使部分经蝶垂体微腺瘤切除手术准确、安全、微创、有效,在一定程度上扩大了经蝶激素分泌型垂体微腺瘤切除手术的适应证,并能有效避免术者和患者接受X线的辐射危害。

Objective To summarize our experiences and results in clinical application of neuronavigation in transsphenoidal micro- surgery of specific hormone - secreting pituitary microadenomas, and to discuss its indications. Methods Totally 59 cases of transsphe- noidal microsurgcry for specific hormone - secreting pituitary microadenomas under ncuronavigation were reviewed. The indications for neuronavigation in transsphenoidal microsurgery included：recurrent pituitary microadenomas after former transsphenoidal surgery in 7 ea- ses, extremely laterally or deeply situated microadenomas in 45 cases, skull base anomalies due to osteodysplasia fibrosa in 3 cases, poor pneumatization of the sphenoid in 1 case, narrow space between bilateral internal carotid arteries in 3 cases. Results All the 59 cases were successfully operated under neuronavigation. The tumors were totally removed in 57 cases and subtotally removed in 2 cases. Postoperative complications included transient fluid and electrolyte imbalance in 31 cases. There were no mortality and permernent morbidity. All the patients were followed up for 3 to 62 months. All the 2 microprolactinomas were cured. Among the 10 GH - secreting adenomas, 8 wered cured, 1 improved and 1 ineffective. Among the 47 ACTH - secreting adenomas, 39 wered cured, 1 improved and 7 ineffective. There were 7 recurrent ACTH - secreting adenomas, among which 6 were cured and 1 ineffective. Conclusion Transsphenoidal micro- surgery under neuronavigation can be applied for hormone - secreting pituitary microadenomas in above specific indications. It is an accu- rate, safe, mini - invasive and effective approach for specific pituitary microadenomas, which can not only expand the indication of transs- phenoidal microsurgery for hormone - secreting pituitary microadenomas, but also reduce the harmful exposure of X - rays for the operating staff and the patients themselves.