神经内镜下经鼻蝶治疗伴甲介型蝶窦垂体腺瘤

Endonasal transsphenoidal surgery under neuroendoscope for conchiform sphenoid sinus pituitary adenoma

目的探讨伴甲介型蝶窦的垂体腺瘤手术治疗方法。方法回顾性分析12例甲介型蝶窦垂体腺瘤病人的临床资料。术前行CT多平面重建，术中应用神经内镜经鼻蝶入路结合磨钻暴露鞍底，切除垂体腺瘤。结果未使用定位设备的情况下，术中均能顺利暴露鞍底，切除肿瘤。术后MRJ复查示肿瘤全切除10例，次全切除2例，无严重并发症发生。随访6—12个月，病人恢复良好。结论经鼻蝶人路手术治疗甲介型蝶窦的垂体腺瘤，通过术前详细的影像学检查、术中神经内镜结合磨钻的使用，均能准确辨认及暴露鞍底、切除肿瘤，是一种创伤小、治疗效果良好的微侵袭神经外科手术方法。

Objective To explore the surgical treatment of pituitary adenoma with conchiform sphenoid sinus. Methods Clinical data of 12 pituitary adenoma patients with conchiform sphenoid sinus were analyzed retrospectively. Preoperative CT multiplanar reconstructions were performed. An endoscope was used to guide the intraoperative sellar floor exploration and tumor resection with microdrill via transsphenoidal approach. Results The sellar floor exposure and tumor resection were accomplished successfully without the intraoperative localization equipment. Postoperative MR/indicated that total resection was achieved in 10 patients and subtotal resection in 2. No serious complication occurred. All the patients were followed up for 6 to 12 months and recovered well. Conclusion Endoscopic surgery of pituitary adenoma with conchiform sphenoid sinus via transsphenoidal approach can accurately expose the sellar floor and remove the tumor by the aid of detailed preoperative imaging examination and intraoperative usage of microdrill, which is a minimally invasive neurosurgery procedure with less trauma and good effect.