神经内镜下经鼻蝶窦入路垂体腺瘤切除术中的鞍底重建策略

Strategy of sellar floor reconstruction of resection of pituitary adenoma via neuroendoscopic transsphenoidal approach

目的探讨神经内镜下经鼻蝶窦入路垂体腺瘤切除术后鞍底重建的方法和效果。方法回顾性分析2006年8月至2014年8月内蒙古自治区人民医院神经外科收治的115例垂体腺瘤患者的临床资料。所有病例均行神经内镜下单鼻孔经蝶窦入路垂体腺瘤切除术。对97例术中无明显脑脊液漏者采用人工硬膜重建鞍底硬膜（简单修补术）；18例发生脑脊液漏者取皮下脂肪、肌肉、筋膜及人工硬膜分层修补重建鞍底（复杂修补术）。随访时间为6～36个月，平均25．5个月。结果全切除97例（84．3％），大部切除18例（15．7％）。86例完成随访，29例失随访。随访期内无一例发生脑脊液漏。结论对于采用神经内镜下单鼻孔经蝶窦入路切除垂体腺瘤的患者，术中根据是否发生脑脊液漏并采取相应鞍底重建策略能有效防止术后脑脊液漏，减少术后并发症。

Objective To investigate the methods and effect of sellar floor reconstruction after resection of pituitary adenoma via neuroendoscopic transsphenoidal approach. Methods From August 2006 and August 2014, the clinical data of 115 patients with pituitary adenoma admitted to the Department of Neurosurgery, Inner Mongolia People＇ s Hospital were analyzed retrospectively. All patients underwent resection of pituitary adenoma via single nostril neuroendoscopic transsphenoidal approach. Ninety-seven patients with no obvious cerebrospinal fluid leakage during the operations were treated with artificial dural reconstruction of the sellar floor dura （ simple repair）. Subcutaneous fat, muscle, fascia, and artificial dura layer repair were used to reconstruct the sellar floor dura in 18 patients with cerebrospinal fluid leakage （complex repair）. The follow-up time ranged from 6 to 36 months （mean, 25.5 months）. Results The pituitary adenomas of 97 patients （84. 3% ） were resected completely and 18 （15. 7% ） were resected subtotally. A total of 86 patients completed follow-up and 29 lost to follow up. None of the patients experienced cerebrospinal fluid leakage within the follow-up period. Conclusions For patients whose pituitary adenomas were resected via single nostril neuroendoscopie transsphenoidal approach, taking the corresponding sellar floor reconstruction strategy can effectively prevent postoperative cerebrospinal fluid leakage and reduce postoperative complications according to whether occurring cerebrospinal fluid leakage or not during the operations.