锁孔手术切除鞍区肿瘤及垂体柄的保护

Minimally invasive surgery through keyhole approach for sellar tumors and intraoperative protection of pituitary stalk

目的探讨锁孔手术切除鞍区肿瘤的效果,以及术中垂体柄的保护方法。方法回顾性分析2014年6月至2017年3月采用锁孔手术切除的36例鞍区肿瘤临床资料,采用眶上锁孔入路和翼点锁孔入路。结果术后病理证实,垂体腺瘤13例,脑膜瘤14例,颅咽管瘤9例。肿瘤全切除33例,近全切除3例。垂体柄全保留32例,部分保留3例,术中未发现垂体柄1例。近全切除3例术后行伽玛刀治疗。所有病例术后随访3个月~2年,均未见肿瘤复发。结论锁孔手术治疗鞍区肿瘤,既安全、便捷、微创,又能达到切除肿瘤、保护垂体柄等重要结构的目的。

Objective To investigate the technique of minimally invasive surgery through keyhole approach for sellar tumors and the strategy of protection of pituitary stalk during the operation. Methods The microsurgery through supraorbital keyhole approach or pterional keyhole approach was performed in 36 patients of with sellar tumors diagnosed by brain CT and MRI examinations. The neuroendoscope, electrophysiological monitoring, and cut-ultrasound aspiration were intraoperatively used for the decrease in the surgery-side injury. Results The pathological examination after the surgery showed that of 36 patients with sellar tumors, 13 had of pituitary adenomas, 14 meningiomas, and 9 craniopharyngiomas. The total resection of the tumors was achieved in 33 patients , and subtotal resection in 3. The pituitary stalk was completely reserved in 32 patients, and partly in 3 and no pituitary stalk was found in 1 with craniopharyngioma. Transient diabetes insipidus occurred in 11 cases and seizures occurred in 1 cases after the surgery. No patient died from the operation and there were not complications related to the keyhole approach. Conclusions Keyhole approach can be used as an approach for surgical treatment of the sellar tumors, because it has the advantages such as safety, convenient and minimally invasive resection of the tumors and good of resection protection of the pituitary stalk and other important structures.