神经内镜辅助下扩大经鼻蝶窦入路治疗鞍区非垂体腺瘤性病变

Extended transsphenoidal surgery assisted with neuroendoscopy for non-pituitary adenoma lesion in the sellar region

目的探讨神经内镜辅助下扩大经蝶窦入路切除鞍区非垂体腺瘤性病变的可行性和安全性。方法回顾性分析11例鞍区非垂体腺瘤性病变病人的临床资料，其中鞍结节脑膜瘤5例。脊索瘤4例，鞍上颅咽管瘤2例。均在神经导航定位下行扩大经鼻蝶窦入路，以内镜和显微镜结合切除鞍区病变。结果肿瘤全切除9例，其中5例鞍结节脑膜瘤均达SimpsonI级切除：次全切除2例，均为脊索瘤。术后3例发生脑脊液漏需二次手术修补。2例脊索瘤次全切除病人行常规放疗。随访6。58个月．3例脑脊液漏病人经再次手术修补均治愈；M对复查均未见肿瘤复发；本组无死亡病例。结论神经内镜辅助下扩大经蝶窦入路切除鞍区非垂体腺瘤性病变是安全可行的。

Objective To evaluate the feasibility and safety of extended transsphenoidal surgery assisted with neuroendoscopy for non-pituitary adenoma lesion in the sellar region. Methods Clinical data of 11 patients with non-pituitary adenoma lesion in the sellar region were analyzed retrospectively, including 5 tuberculum sellae meningioma, 4 chordoma and 2 suprasellar craniopharyngioma. Extended transsphenoidal surgery under neuronavigation was performed in all the patients, and the tumor removed under endoscope and microscope. Results Total tumor removal was accomplished in 9 patients, of whom 5 tuberculum sellae meningiomas achieved Simpson I resection, and subtotal removal was accomplished in 2 patients with chordoma. Cerebrospinal fluid leakage occurred in 3 patients postoperatively and had to have secondary repair. Two chordoma patients with subtotal removal accepted radiotherapy after surgery. During the follow-up period of 6 to 58 months, 3 patients with cerebrospinal fluid leakage were cured and no patient recurred by MRI reexamination, and no patient died. Conclusion Extended transsphenoidal surgery assisted with neuroendoscopy for non-pituitary adenoma lesion in the sellar region is safe and feasible.