额底纵裂入路切除鞍区中线巨大肿瘤

Removal of giant midline sellar tumor via frontobasal interhemispheric approach

目的探讨经额底纵裂入路切除鞍区中线巨大肿瘤的手术策略技巧、优势及疗效。方法回顾性分析28例采用额底纵裂入路切除鞍区中线巨大肿瘤病人的临床资料,术中直视下切除肿瘤25例,神经内镜辅助下直视切除3例。结果肿瘤全切除23例,近全切除5例;完整保留垂体柄19例,切除垂体柄5例,未见垂体柄4例。术后病理:垂体腺瘤8例,颅咽管瘤9例,脑膜瘤6例,视神经胶质瘤4例,颗粒细胞瘤1例。术后暂时性尿崩及电解质紊乱15例,下丘脑功能轻度低下3例,无手术死亡病例。随访6个月,MRI复查发现肿瘤复发1例。结论额底纵裂入路对胼胝体膝部至鞍结节范围内的鞍区重要解剖结构均可良好暴露,可为术者提供安全广阔的手术视野,在直视下切除鞍区中线肿瘤,易于保护邻近重要结构,术后并发症少,效果佳。

Objective To explore the surgical strategies,skills,advantages and clinical outcomes for resection of giant midline sellar tumors via frontobasal interhemispheric approach.Method Clinical data of 28 patients with giant midline sellar tumors undergoing resection via frontobasal interhemispheric approach were analyzed retrospectively.The tumor resection under direct vision was performed in 25 patients and resection under direct vision assisted with neuroendoscopy was performed in 3.Result Total tumor resection was achieved in 23 patients and subtotal resection in 5.The pituitary stalk was completely preserved in 19 patients,resected in 5 and not displayed in 4.Postoperative pathological examination showed 8 pituitary adenomas,9 craniopharyngiomas,6 meningiomas,4 optic gliomas and 1 granular cell tumor.Temporary diabetes insipidus and electrolyte disturbance occurred in 15 patients,mild hypothalamic hypofunction in 3 and no patient died after operation.During a follow-up of 6 months,MRI found 1 recurrent case.Conclusions The important anatomical structures of the sellar region from the genu of the corpus callosum to tuberculum sellae can be well exposed via frontobasal interhemispheric approach.The approach provides a safe and wide surgical field of vision,and the tumor can be excised under direct vision,thus being apt to protect the around important structures with few postoperative complications and good therapeutic effects.