神经导航引导下内镜经蝶入路切除鞍上型巨大垂体瘤

Image-guided endoscopic transnasal transsphenoidal approach for treatment of suprasellar giant pituitary adenoma

目的探讨神经内镜及神经导航用于经鼻蝶入路治疗鞍区肿瘤的临床应用及手术技巧。方法对2007-03—2013-11间收治的32例鞍上型巨大垂体肿瘤实施神经内窥镜结合神经导航技术经鼻蝶手术切除。结果本组肿瘤全切除24倒,近全切除6倒,大部分切除2例。术后患者症状均有不同程度改善。2例患者出现一过性脑脊液漏,5例出现尿崩症,其中1例需长期口服弥凝,无其他严重并发症发生。结论内镜技术经鼻蝶手术治疗垂体肿瘤,具有对鼻腔正常结构损伤小、暴露清楚等特点,特别是对于传统显微镜手术不能暴露的鞍上结构显露满意。结合导航技术能提高肿瘤的全切率及手术的安全性。

Objective To discuss the clinical application and technique of endocope and neuronavigation in transnasal transsphenoidal approach for treatment of suprasellar giant pituitary adenoma. Methods From Mar. 2007 to Nov. 2013,32 patients undervent image- guided endocopic transnasal transsphenoidal approach surgery for pituitary adenoma. Results The tumor was totally removed in 24 cases,subtotally removed in 6 cases,and partially removed in 2 cases. After patients obtained an improvement in clinical symptoms at some extent after the operation. Postoperative,transient cerebrospinal fluid leakage occurred in 2 cases,transient diabetes insipidus occurred in 5 cases,1 case developed diabetes insipidus. None of the patients suffered from permanent complications. Conclusion The advantage of endoscopic transnasal transsphenoidal approach for the treatment of tumor in sellar region are minimal injury to nasal cavity,provision of a wide view,especially in the suprasellar region which can not be directly invisualized under the traditional microcopic surgery. incorporated with image- guided technique,the saety of the surgery and the rate of total tumor removal were improved.