内镜经鼻蝶扩大入路手术治疗鞍结节脑膜瘤

Resection of tuberculum sellae meningiomas via endoscopic extended transsphenoidal approach

目的探讨内镜下经鼻蝶扩大入路切除鞍结节脑膜瘤的可行性、手术技巧及并发症的防治。方法回顾性分析19例内镜下经鼻蝶扩大入路鞍结节脑膜瘤切除患者临床资料、手术疗效、并发症、长期随访结果。结果19例中9例实现Simposon I级切除，8例II级切除，2例III级切除。6例头痛均好转，16例视力视野损害患者术后改善14例，2例发生脑脊液漏，其中1例并发颅内感染，12例出现嗅觉损害。随访4～31个月无迟发型脑脊液漏、癫痫、尿量改变、垂体功能减退等并发症。10例嗅觉损害患者术后随访12个月时均得到部分恢复。结论内镜下经鼻蝶扩大入路切除鞍结节脑膜瘤是可选的理想手术入路。

Objective To investigate the feasibility, surgical technique, prevention and management of postoperative complications in tuberculum meningiomas resection via endoscopic extended transsphenoidal approach （EETA）. Methods Clinical data, surgical effect, complications and follow-up outcomes of 19 patients who underwent surgical removal of tuberculum meningiomas via EETA were analyzed retrospectively. Results Tumor resection of Simposon level I was achieved in 9 cases, level II in 8, and level III in 2. After operation, headache got relieved in 6 cases, the visual damage and optic field defect were improved in 14 of 16 cases with preoperative visual impairment. Cerebrospinal fluid rhinorrhea occurred in 2 cases with intracranial infection in one of them. Olfactory damage occurred in 12 cases. Postoperative follow-up for 4 to 31 months revealed no complications such as delayed cerebrospinal rhinorrhea, epilepsy, change in urine output, endocrine insufficiency and others. One-year follow-up showed partially function restoration in 10 of 12 cases with postoperative olfactory damage. Conclusion Endoscopic extended transsphenoidal approach is an ideal alternative for resection of tuberculum meningiomas.