经眶—额下入路手术联合术后X刀治疗大型垂体腺瘤

Management of large pituitary adenoma:Transorbital subfrontal approach operations associated with postoperative X-knife therapy

目的 探讨大型垂体腺瘤的根治方法与手术安全性。 方法 1999年 1月～ 2 0 0 2年 4月我院对 14例大型、巨大型垂体腺瘤采用一侧眶 -额下入路手术 ,尽可能充分地切除肿瘤 ,至少做到将肿瘤的鞍上部分完全切除。术后 1 5～ 3 5个月内X刀进一步治疗鞍内残瘤。 结果 肿瘤全切除 4例 ,鞍内残留 10例 ,无一例出现严重手术并发症。 8例残瘤术后行X刀治疗 ,未出现视力损害和垂体功能减退。X刀补充治疗的 8例随访 5～ 2 6个月 ,平均 14 8个月 ,无一例肿瘤复发。 结论眶-额下入路手术操作方便 ,利于充分切除肿瘤和减少手术并发症。术后加行X -刀治疗可能控制肿瘤复发。

Objective To assess the technique and the safety of radical resection for large pituitary adenoma. Methods Unilateral transorbital subfrontal approach operations were employed for treating 14 cases of large or giant pituitary adenomas. Tumors, at least the suprasellar extension of them, were removed as thoroughly as possible in surgery. Then the X-knife was administered for intrasellar residual lesions 1.5～3.5 months after the surgery. Results Total removal of tumors was achieved in 4 patients, while intrasellar residual tumors were found in the remaining 10 patients. No severe complications occurred. Out of the 10 patients with residual tumors, 8 underwent postoperative X-knife therapy, without visual defects or pituitary function failure. Follow-up observations in these 8 patients for 5～26 months (mean,14.8 months) revealed no recurrence. Conclusions Transorbital subfrontal approach surgery which is characterized by simplicity of its performance facilitates the radical resection of tumors and the avoidance of complications. Postoperative X-knife therapy may further control the recurrence of tumors.