神经导航辅助下经单鼻孔蝶窦人路手术切除蝶窦发育异常垂体腺瘤（附18例临床报告）

Tram-single nostril-sphenoid approach for pituitary adenomas in patients with sphenoid sinus dysplasia through neuronavigafion system： a report of 18 cases

目的探讨神经导航在单鼻孔经蝶入路切除蝶窦发育异常垂体腺瘤中的应用价值。方法选择北京军区总医院附属八一脑科医院自2010年12月至2011年12月收治的18例蝶窦发育异常的垂体腺瘤患者，分析神经导航引导下单鼻孔蝶窦人路手术对该病的治疗效果。18例患者中，蝶窦发育异常类型包括甲介型2例，鞍前型4例，多房分隔9例，过度气化达两侧中颅窝底3例。结果肿瘤定位准确18例（100％），肿瘤全切14例（77．8％）。术后13例患者（72．2％）内分泌治愈。术后尿崩4例（22．2％），均为一过性；术后脑脊液漏1例（5．6％），通过腰穿置管治愈；无颈内动脉、海绵窦损伤等严重并发症。结论神经导航辅助经鼻蝶手术切除蝶窦发育异常垂体腺瘤定位准确，手术效果好，副损伤少，一定程度上扩展了手术适应证。

Objective To assess the value of neuronavigation system in surgery for pituitary adenomas in patients with sphenoid sinus dysplasia via single nostril-sphenoid approach. Methods Neuronavigation system guided tram-single nostril-sphenoid surgery was performed on 18 patients with sphenoid sinus dysplasia, admitted to our hospital from December 2010 to December 2011; 2 patients were without sphenoid sinus, 4 with sphenoid sinus front of sella, 9 of sphenoid sinus being separated several rooms, and 3 of excessive gasification to 2 sides of middle cranial fossa. Results The positioned accuracy rate was 100%, and total resection rate was 77.8%. Thirteen patients （72.2%） were cured enjoying good endocrine result. No such severe postoperative complications as internal carotid artery and cavernous sinus injuries were noted in all the patients, except that transient polyufia occurred in 4 （22.2%） and CSF leakage in 1 （5.6%）. Conclusion The neuronavigator-assisted trans-sphenoidal surgery in patients with sphenoid sinus dysplasia is helpful in improving the security of trans-sphenoidal surgery and reducing the local injury and serious complications, which extends the surgical indications to some extent.