内镜辅助颞下锁孔入路治疗侵袭性垂体腺瘤探讨

Investigation of endoscope-assisted subtemporal keyhole approach for treatment of invasive pituitary adenoma

目的探讨采用颞下锁孔入路治疗骑跨中后颅窝的侵袭性垂体腺瘤的疗效及手术技巧。方法所有患者均采用神经内镜辅助下颞下锁孔入路行肿瘤切除,术中利用神经内镜观察,术后复查MRI及内分泌水平等评估手术效果。结果4例垂体腺瘤均次全切除,术后激素水平下降者2例,所有患者头痛、头晕症状均较术前明显缓解。2例侵犯海绵窦的垂体腺瘤术后新发生颅神经功能障碍者1例(复视),垂体功能低下1例。随访6个月,所有患者肿瘤均未复发。结论采用神经内镜辅助颞下锁孔入路治疗骑跨中后颅窝的垂体腺瘤是此类患者可供选择的手术方法。对解剖学知识的熟悉以及拥有娴熟的显微外科技术、丰富的手术实践经验是成功进行此类手术治疗的先决条件。

Objective To investigate the therapeutic effect and operation skills of subtemporal keyhole approach for the treatment of in- vasive pituitary adenoma occupying the middle and posterior cranial fossae. Methods Four patients with invasive pituitary adenoma were treated with endoscope-assisted subtemporal keyhole approach for excision of the tumor, and endoscopic observation was performed during surgery. The surgical outcomes were evaluated based on MRI and endocrine levels. Results All cases underwent subtotal resec- tion of pituitary adenoma. After operation, 2 cases had decreased hormone levels, and all had markedly relieved headache and dizzi- ness. In the 2 cases of pituitary adenoma invading the cavernous sinus, 1 had cranial nerve dysfunction （diplopia） after operation, and the other had hypopituitarism. Six months of follow-up revealed no tumor recurrence. Conclusions Endoscope-assisted subtemporal keyhole approach is feasible for the treatment of pituitary adenoma in the middle and posterior cranial fossae. The prerequisites for such operation in the treatment are familiarity with the anatomy, microsurgical skills, and rich operation experience.