神经导航在垂体巨大腺瘤再次经鼻蝶入路手术中的应用

Application of neuronavigation in re-operation via transsphenoidal approach for patients with giant pituitary adenoma

目的探讨神经导航在垂体巨大腺瘤再次经鼻蝶入路手术中的应用价值。方法回顾性分析2017年6月至2019年6月在神经导航辅助下进行再次手术治疗的27例垂体巨大腺瘤的临床资料。结果术后视力及视野缺损明显改善10例,部分改善14例,无明显改善3例;血清皮质醇水平降低6例,正常21例。7例术前血清泌乳素增高中,6例术后降至正常;1例仍偏高。5例术前生长激素升高病人,术后生长激素降至正常。15例术前头晕头痛中,术后改善12例,无明显变化3例。2例术后出现脑脊液漏,经卧床及腰椎穿刺术置管引流后治愈。术后3个月复查MRI,显示肿瘤全切除22例,次全切除3例,部分切除2例。未全切除病人3个月后行伽玛刀治疗。结论垂体巨大腺瘤再次经鼻蝶入路手术时,在解剖结构破坏的情况下,利用神经导航可以引导术者准确到达病灶,降低手术风险,提高肿瘤全切除率。

Objective To investigate the value of neuronavigation in the re-operation via transsphenoidal approach for the patients with giant pituitary adenoma.Methods The clinical data of 27 patients with giant pituitary adenoma who underwent reoperation via transsphenoidal approach under neuronavigation guidance from June 2017 to June 2019 were retrospectively analyzed.Results Of 27 patients,22 patients had complete tumor resection,3 patients had subtotal resection,and 2 patients had partial resection.Postoperative visual acuity and visual field defects were significantly improved in 10 patients,partially improved in 14,and not significantly improved in 3.The serum levels of cortisol were decreased in 6 patients and normal in 21 after the operation.Of 7 patients with increase in the serum level of prolactin preoperatively,the serum levels of prolactin were restored to normal level in 6 patients and still increased in 1 patient after the operation.The serum levels of growth hormone were restored to normal level after the surgery in 5 patients who had elevated level of the growth hormone before the operation.Of 15 patients with dizziness and headache before the operation,the dizziness and headache were improved 12 patients and no obvious change in 3 patients after the operation.Cerebrospinal fluid leakage occurred in 2 patients after the operation,and were cured by drainage via lumbar puncture.The MRI which was performed 3 months after the operation showed total tumor resection in 22 patients,subtotal resection in3,and partial resection in 2.Conclusion When the giant pituitary adenoma is operated again through the transsphenoidal approach under the condition of anatomical structure destruction,the neuronavigation can be used to guide the surgeon to reach the lesion accurately,reduce the surgical risk,and increase the total tumor resection rate.