经纵裂蝶窦入路切除蝶鞍区巨大肿瘤

Microsurgical treatment of giant sellar tumor via interhemispheric transsphenoidal approach

目的 探讨切除巨大蝶鞍区肿瘤的手术入路及技巧。 方法 经纵裂蝶窦入路显微手术治疗 5 6例巨大蝶鞍区肿瘤 ,做额骨跨中线小型骨瓣 ,扩大骨窗前缘达前颅窝底 ,经纵裂达蝶鞍区 ,磨除鞍结节、蝶骨平台及蝶鞍前壁骨质 ,显露并切除鞍上、鞍内及蝶窦内肿瘤。切除肿瘤后 ,根据情况行颅底重建。 结果 肿瘤全切除 43例 (76 8% ) ,次全切除 6例 ,大部切除 7例。术后死亡 4例(7 1% )。 结论 该手术入路可较好地显露蝶鞍、蝶窦、鞍上、鞍旁及鞍后。适合切除蝶鞍区巨大肿瘤 。

Objective To study the operative approach of giant sellar tumors and the skills of microsurgical treatment. [WT5”HZ]Methods[WT5”BZ] 56 cases of huge sellar tumors were removed by the interhemispheric transphenoidal approach. After cutting a medial frontal bone flap and reaching the sellar area through the interhemisphere, the tuberculum sellae, planum sphenoid, and anterior sellar wall were removed by microdrill, and then the tumor in suprasellar, intrasellar, and sphenoid sinus was exposed and excised. Skull base was reconstructed made in some patients. Results Total removal of tumor was achieved in 43 patients (76 8%), and subtotal removal in 6. Four patients died of complications after operation. Conclusions This approach can expose sufficiently the suprasellar, intrasellar, parasellar, postsellar regions and the sphenoid sinus, and remove huge sellar tumors, especially theose invaded sphenoid sinus and complicated by prefixed optic chiasm.