额底纵裂入路手术对鞍上第三脑室底垂体瘤的疗效分析

Analysis of the Efficacy of the End Inter Hemispheric Approach Surgery on the Treatment of Pituitary Tumors in Saddle of the Third Ventricle Bottom

目的：分析经额底纵裂入路治疗鞍上第三脑室底垂体瘤的疗效，探讨其临床适用性。方法：选择从2011年1月~2013年1月与我院行额底纵裂入路手术治疗的30例鞍上第三脑室底垂体瘤的患者，术中行单侧额或双侧额弧形切口，根据术中所见肿瘤位置，由终板、视神经一颈内动脉等存在的生理间隙处切除肿瘤，观察所有患者的手术疗效。结果：所有患者术中可见肿瘤位于鞍内鞍上，部分或全部突入第三脑室底，其中有6例患者伴有脑积水。术中肿瘤全切23例，次全切5例，大部切除2例，无手术死亡病例。术前25例患者视力减退，术后23例患者视力均获得不同程度改善，仅1例暂无明显变化。术后19例出现电解质紊乱，患者经治疗后均已纠正；12例出现不同程度的尿崩症，给予患者药物治疗后，病情得到缓解。术后随访6个月，23例肿瘤全切患者病灶无复发，另外4例次全切者病灶也无明显变化，仅1例次全切和2例大部切除患者于术后行伽马刀再次治疗。结论：经额底纵裂入路治疗鞍上第三脑室底垂体瘤可以达到视野清晰，直观下进行肿瘤切除，手术效果好，并发症较少，适合临床长期推广应用。

Objective： To analyze the efficacy of the end inter hemispheric approach surgery on the treatment of pituitary tumors in the saddle on the third ventricle bottom. Methods： 30 cases who were treated with the saddle third ventricle pituitary tumor in our hospital from January 2011 to January 2013 were selected to take the amount at the end inter hemispheric surgical treatment. During the operation, we used unilateral or bilateral frontal curved incision, and according to the location of the tumor surgery, we conducted resection of the tumor at the physiological gap, then we observed and compared the treatment efficacy of patients. Results： The tumors were located on the saddle of the patients, some of them were broke into the end of the third ventricle which included six patients with hydrocephalus. The intraoperative tumor of 23 cases were total resected, five cases were subtotal resected, two cases were resected by the most, the resection was successful with no death. Before the operation, 25 cases were hypopsia. But after the operation, 23 patients were improved, only one case was not improved. 19 eases showed the electrolyte imbalance, but were promptly corrected by medicine; 12 cases of diabetes insipidus were in remission after drug treatment. A1 the patients were followed up for six months, 23 cases of total resection without recurrence, four patients were cut lesions, one case of subtotal and another two of subtotal line with gamma knife retreatment. Conclusions： The inter hemispheric approach by the pituitary tumor saddle on the bottom of the third ventricle could achieve clear vision, intuitive tumor resection, good surgical results, and fewer complications, and it is suitable for long-term clinical application.