内镜经鼻蝶窦入路治疗侵袭海绵窦垂体腺瘤

Endoscopic endonasal transsphenoidal approach for pituitary adenomas invading cavernous sinus

目的 通过回顾性分析内镜经鼻蝶窦入路治疗侵袭海绵窦的垂体腺瘤,探讨神经内镜治疗侵袭海绵窦垂体腺瘤的有效性和安全性。方法 收集北京天坛医院神经外科从2008年4月至2013年4月收治的135例海绵窦垂体腺瘤,均采用内镜经鼻蝶窦入路.无功能腺瘤86例、PRL腺瘤28例、GH腺瘤18例、ACTH腺瘤2例、TSH腺瘤1例.Knosp 3级57例、4级78例.术后对患者进行长期随访.结果 全切除40例（29.6％）,次全切除45例（33.3％）,大部切除42例（31.1％）,部分切除8例（5.9％）。并发症：脑脊液鼻漏4例（3.0％）,视力下降3例（2.2％）,尿崩5例（3.7％）,死亡1例（0.7％）。随访到125例（92.6％）。80例无功能腺瘤中22例治愈,残留58例中21例行γ-刀治疗、6例行普通放疗、31例观察。26例PRL腺瘤中内分泌学治愈7例,19例予溴隐亭治疗。GH腺瘤16例,内分泌学治愈4例,9例行γ-刀治疗,3例观察。结论 内镜经鼻蝶窦入路是治疗侵袭海绵窦的垂体腺瘤的一种安全、有效的方法,部分患者需结合药物和放疗。

Objective To investigate the effects of endoscopic endonasal transphenoidal approach in the treatment of pituitary adenomas invading the cavernous sinus （CS）.Methods A retrospective analysis was performed in 135 pituitary adenomas extending to CS treated via endoscopic endonasal transphenoidal approach between April 2008 and April 2013.The most common adenoma type was non-functioning pituitary adenomas （NFPAs） （86 cases,63.7%）,followed by PRL-secreting adenomas （28 cases,20.7%）,growth hormone （GH）-secreting adenomas （18 cases,13.3%）,ACTH-secreting adenomas （2 cases,1.5%）,and TSH-secreting adenomas（1 cases,0.7%）.The average diameter of the tumors was （30.0 ＆#177; 1.1）mm（10-69 mm）.The shapes of the tumors were as the following：round （97 cases,72.6%）,dumb bell （8 cases,5.9%）,and multi-lobe （30 cases,21.5%）.The patients were divided into two groups according to the Knosp classification：third grade （57 cases,42.2%） and fourth grade （78 cases,57.8%）.Results Gross total resection was achieved in 40 patients （29.6%）,subtotal （〉90%） in 45 （33.3%）,partial （〉70%） in 42 （31.1%）,and decompression （〈70%） in 8 （5.9%）.There were 4 patients （3.0%） accompanied with postoperative cerebraospinal fluid leak,2 with visual decrease,and 5 with transient diabetes insipidus.One paient died due to postoperative intracranial hematoma.In 18 patients with GH-secreting adenomas,4 achieved endocrinological remission after surgery,and 9 significant GH decrease.In 28 patients with PRL-secreting adenomas,6 had a normal serum PRL level within one week postoperatively,and 21 remarkable PRL decrease.Conclusions The endoscopic endonasal transphenoidal approach was a safe and effective option for the resection of pituitary adenomas invading the CS.