经颅和经蝶分期手术治疗巨大垂体腺瘤21例疗效分析

Staged transcranial and transsphenoidal surgery for giant pituitary adenomas： a retrospective study of 21 cases

目的探讨采用先经颅后期再经蝶分期手术切除巨大垂体腺瘤的疗效。方法回顾性分析四川大学华西医院神经外科2012年1月至2015年12月手术治疗的巨大垂体腺瘤病人临床及影像学资料，并进行随访。结果2012年1月至2015年12月四川大学华西医院神经外科共收治1538例垂体瘤手术病人，其中21例巨大垂体瘤采用先经颅入路手术切除大部分肿瘤后，后期再经蝶手术切除蝶鞍内残余肿瘤，其中全切7例，次全切除11例，大部分切除3例。术后无死亡病例，无颅内出血等并发症，术后颅内感染1例，脑脊液鼻漏3例，均经积极治疗痊愈。结论根据病史和术前影像学资料对巨大垂体腺瘤的生长形态及质地进行分析，针对肿瘤大部分位于鞍膈之上呈不规则生长或质地较硬的巨大垂体腺瘤，选择先经颅再经蝶分期手术是一种安全有效治疗方式，术后疗效好，并发症少。

Objective To investigate the effect of the second-stage transcranial and transsphenoidal approach for giant pituitary tumors. Methods A retrospective review of 21 patients, who had undergone the transcranial surgery and then transsphenoidal surgery for giant pituitary adenomas from 2012 to 2015 in the neurosurgery department of West China Hospital, was performed. Visual findings, endocrine presentation, complications, and tumor types were collected. All data were based on clinical feature, MRI, and follow-up. Results Among the 21 cases, gross total resection of tumor was achieved in 7 of all patients, subtotal in 11, and partial in 3. No intracranial hemorrhage or death occurred postoperatively. Postoperative infectionoccurred in one patient and cerebrospinal fluid leakage occurred in 3 patients. Four patients recovered after treatment. Conclusion According to the clinical feature and MRI, it is safe and effective to choose the transcranial surgery and then transsphenoidal surgery for specific giant pituitary adenomas, which can improve treatment effects and reduce postoperative complications.