Microsurgical Resection of Pituitary Adenoma via Single-Nostril Transsphenoidal Approach

OBJECTIVE To explore the methods and experience of thesingle-nostril transsphenoidal approach for treating pituitaryadenomas.METHODS We retrospectively analyzed 46 patients whohad pituitary tumors and received surgery via the singlenostriltranssphenoidal approach and observed the effects andcomplications of surgery. The specific surgical methods are: a nasalspeculum is inserted slowly through the right nostril towards theanterior wall of the sphenoid sinus. A 1.5 cm incision is made intothe nasal mucosa in the right nasal cavity at the level of the middlenasal turbinate. By fracturing the bony septum, a space is formedbetween the bilateral nasal mucosa and the bony septum of thesphenoid sinus. Then, the inside of the sphenoid sinus is exposed.The remaining part of the bony septum, the anterior sphenoidsinus wall, and the sphenoid mucosa are gradually removed. Theanterior sphenoidotomy is less than 1.5 cm wide. After confirmingthe tumor by dural puncture, a cross incision of the dura is made,and the tumor is slowly removed by curette. The sella is usuallycollapsed and visible after the total tumor removal. When thetumor is resected satisfactorily, gelatin sponges are placed into theoperative cavity to stop bleeding.RESULTS Postoperative MRI scans revealed that among the 46cases, total resection of the tumor was achieved in 34 cases andsubtotal in 12. No deaths or disability occurred, and the hormonelevels of almost all patients improved. Signs of diabetes insipidusoccurred in 17, electrolyte disturbances in 5, and there were noreports of postoperative cerebrospinal fluid rhinorrhea.CONCLUSION The direct single nostril transsphenoidalapproach of continuous improvement has the advantages ofa convenient approach, simplified operation, safety and highefficiency.

Trans-nasosphenoid pituitary adenoma microsurgery in 100 cases

The rhinologist participating in microsurgery of the pituitary adenomaplays an important role in relieving the patients from suffering and indecreasing the incidence of complications.This paper summarily reportsrhinological aspects in 100 cases undergoing trans-nasosphenoid intrasellarmicrosurgery,including operative routes and incisions,methods for opening andreconstructing the sellar floor and nasal comPlications.The authors suggest aseptavestibular incision to modify Hirsch’s septal incision,and outline our fivemethods to open and reconstruct the sellar floor.The operator should select themost proper method according to different situations,in operation.The most dan-gerous complications are CSF rhinorrhea with supurative meningitis and fatalhemorrhage.In our experience five such cases were cured by medical and surgicaltreatments.

Neuroendoscopic and microscopic transsphenoidal approach for resection of nonfunctional pituitary adenomas

BACKGROUND Nonfunctional pituitary adenoma is a common type of pituitary adenoma, which can lead to headache, visual field disturbance, and cranial nerve damage due to increased tumor volume. Neuroendoscopic and microscopic transsphenoidal approaches have been widely used in the resection of nonfunctional pituitary adenomas. However, the clinical efficacy in neuroendoscopic and microscopic surgery is still controversial. AIM To explore the clinical efficacy of neuroendoscopic and microscopic transsphenoidal approach for resection of nonfunctional pituitary adenomas. METHODS We retrospectively analyzed 251 patients with nonfunctional pituitary adenomas;138 underwent neuroendoscopic surgery via transsphenoidal approach, and 113 underwent microscopic surgery via transsphenoidal approach between July 2010 and September 2015. All patients were followed up for > 6 mo. Gender, age, course of disease, tumor diameter, tumor location, and percentage of patients with headache, visual impairment, sexual dysfunction, and menstrual disorders were contrasted between the two groups to compare the difference of preoperative data. Cure rate, symptom improvement rate, recurrence rate, the postoperative hospital stay, operating time, intraoperative blood loss, and the incidence of postoperative complications were compared in order to evaluate the advantages and disadvantages of neuroendoscopic and microscopic surgery.RESULTS There was no significant difference in cure rate, symptom improvement rate, and recurrence rate between neuroendoscopy group and microscopy group (82.6% vs 85.8%, P > 0.05;90.6% vs 93.8%, P > 0.05;5.1% vs 9.7%, P > 0.05). In the neuroendoscopy group, the postoperative hospital stay was 8.4 ± 0.6 d;operating time was 167.2 ± 9.6 min;intraoperative blood loss was 83.4 ± 9.3 mL, and the rates of diabetes insipidus and electrolyte imbalance were 4.3% and 8.0%, respectively. The corresponding results in the microscopic group were 11.2 ± 0.6 d, 199.7 ± 9.3 min, 138.8 ± 13.6 mL, and 32.7% and 20.4%, respectively. There were significant differences in postoperative hospital stay, operating time, intraoperative blood loss, and the rates of diabetes insipidus and electrolyte imbalance between the two groups (P < 0.05). CONCLUSION Neuroendoscopic and microscopic transsphenoidal approaches have similar clinical efficacy for the resection of nonfunctional pituitary adenomas. Neuroendoscopic surgery reduces operating time, intraoperative bleeding, postoperative recovery, and complications.

Transsphenoidal microsurgical operation for pituitary adenomas with suprasellar extensions

Objective: To evaluate the feasibility and therapeutic effectiveness of the transsphenoidal microsurgical removal of pituitary adenomas with suprasellar extensions. MethodS: We reviewed the diagnosticmodes, surgical technique, and outcomes of 152 patients suffering from pituitary adenomas with suprasellarextensions who were treated by transsphenoidal microsurgery in our department. Diagnosis was confirmed byCT or MRI scanning. All tumours with diameter >10 mm were characterized by suprasellar extensions. Op.erations were performed via either sublabio-septo-sphenoidal approach or naso-vestibulo-sphenoidal approachunder microscope. A subarachnoid catheter was preoperatively inserted in the lumbar cistern, through whichsaline was slowly injected during operation to increase the intracranial pressure (ICP) so as to deliver thesuprasellar tumour into the operative field to aid the removal. Result: Of the 152 cases, the gross total removal of adenoma in 106 cases (69. 7% ) and subtotal removal in 37 cases (24. 4% ) were achieved, and partial removal was carried out in the remaining 9 cases (5. 9 % ) of fibrous or dumbbell-shaped adenomas. Therewere no deaths after operation in this group. Follow-up review (median 3. 5 years) in 137 patients revealedgood recovery in 97 patients (70. 8% ), and late recurrence in 40 patients (29. 2% ) who need reoperativemanagement, drug therapy, radiotherapy, or radiosurgery used either alone or combined. Conclusion: Microsurgical technique via transsphenoidal approach is a safe and effective way to remove the pitoitary adenomas with suprasellar extensions but not for fibrous or dumbbell-shaped ones.

Rathke Cleft Cyst with a Coexisting Gonadotropin Producing Pituitary Adenoma

Rathke cleft cyst is thought to arise from incomplete obliteration of the lumen of Rathke pouch. The cells of the anterior pituitary lobe, from which pituitary adenomas develop, are also derived from the cells of Rathke pouch. Although Rathke cleft cyst and pituitary adenoma have a shared ancestry, they rarely occur coincidentally. Rathke cleft cysts have been found incidentally in 11% - 33% of post-mortem examinations, and were associated with 1.7% - 2.1% of the pituitary adenoma cases. These coexisting lesions are difficult to diagnose pre-operatively due to the variable signal intensity and position of the Rathke cleft cysts. Treatment of these lesions involves surgical resection to decrease mass effect and medical management to normalize hormonal imbalances. To our best knowledge, only 42 cases of Rathke cleft cyst with a coexisting pituitary adenoma have been reported in the English or Japanese literatures, but none of the coexisting pituitary adenoma is gonadotropin producing. We would like to report a case of Rathke cleft cyst with a coexisting gonadotropin producing adenoma that was successfully treated by endoscopic endonasal transsphenoidal approach with the removal of the sellar lesion and temporary hormone replacement.

3D打印技术用于经鼻蝶窦入路垂体腺瘤切除术应用效果及对血清MMP-9和IGF-1水平的影响

目的:探究3D打印技术在经鼻蝶窦入路垂体腺瘤(PA)切除术的应用效果及对血清基质金属蛋白酶-9(MMP-9)和胰岛素样生长因子-1(IGF-1)水平的影响。方法:选取2020年5月至2022年5月秦皇岛市第一医院收治的84例PA患者,按照随机数表法将其分为观察组和对照组,每组42例。对照组行经鼻蝶窦入路垂体腺瘤切除术,观察组行经鼻蝶窦入路垂体腺瘤切除术联合应用3D打印技术,比较两组肿瘤切除效果、围术期指标、视力改善情况、MMP-9和IGF-1水平,以及鼻腔功能的鼻气道阻力(NAR)、T&T嗅觉测试评分及并发症。结果:观察组肿瘤切除效果优于对照组,差异有统计学意义(U=2.286,P<0.05);观察组手术时间、术中出血量及住院时间均少于对照组,差异有统计学意义(t=4.780、11.438、11.842,P<0.05);术后3 d、7 d时观察组血清MMP-9和IGF-1水平低于对照组,差异有统计学意义(F=7.526、4.985,P<0.05);术后1个月、3个月时观察组NAR及T&T嗅觉测试评分低于对照组,差异有统计学意义(F=6.359、8.436,P<0.05);两组视力视野改善情况及并发症发生率比较,差异无统计学意义(P>0.05)。结论:3D打印技术用于经鼻蝶窦入路垂体腺瘤切除术可提高肿瘤切除效果,优化手术操作,减少创伤,有利于减轻疼痛,改善嗅觉功能与视力视野,并能降低血清MMP-9、IGF-1水平,且安全性较高。

Transsphenoidal approach to pituitary adenoma： surgical technique of the Peking Union Medical College Hospital

Although presented over one hundred years ago, the transsphenoidal approach to pituitary adenoma is still the most suitable and safe route to pituitary adenoma, with a series of significant evolutional steps. The transsphenoidal approach to pituitary adenoma is still a non-universal approach used in different centers of different areas in our country. The transsphenoidal approach has a number of variations, including the endonasal rhinoseptoplastic, transnasal displacement,

锁孔入路切除和鼻蝶窦入路切除对脑垂体瘤患者颅内血肿、脑脊液鼻漏发生率的影响

目的探讨锁孔入路切除和鼻蝶窦入路切除对脑垂体瘤患者颅内血肿、脑脊液鼻漏发生率的影响。方法选取82例脑垂体瘤患者作为研究对象,将其随机分为A组(n=45)和B组(n=37)。其中A组患者行显微镜下锁孔入路切除术,B组患者行神经内镜下鼻蝶窦入路切除术。比较两组患者临床疗效、手术指标、肿瘤全切率和内分泌下降情况以及术后颅内血肿、脑脊液鼻漏发生率。结果治疗后A组治愈19例(42.22%),显效8例(17.78%),有效8例(17.78%),无效10例(22.22%);B组治愈23例(62.16%),显效8例(21.62%),有效4例(10.81%),无效2例(5.41%)。A组有效率(77.78%)低于B组(94.59%)(P<0.05)。A组手术时间(93.42±21.75)min显著长于B组(65.82±17.44)min(P<0.05);住院时间(9.79±1.27)d显著长于B组(6.08±1.16)d(P<0.05);A组术中失血量为(76.71±8.45)ml,显著多于B组(50.62±6.73)ml(P<0.05)。A组中肿瘤全切35例(77.78%),B组全切35例(94.59%);A组出现内分泌激素下降20例(44.44%),B组出现下降25例(67.57%)。A组肿瘤全切率与内分泌激素下降比例均明显低于B组(P<0.05)。A组术后出现颅内血肿和脑脊液鼻漏分别为3例(6.67%)和7例(15.56%),B组出现脑脊液鼻漏2例(5.41%),未出现颅内血肿,A组颅内血肿和脑脊液鼻漏发生率均高于B组,但无明显差异(P>0.05)。结论与锁孔入路切除术相比,鼻蝶窦入路切除垂体瘤对脑垂体瘤患者的疗效更好,能够增加肿瘤全切率,加速患者恢复,且颅内血肿和脑脊液鼻漏发生率明显更低,对患者预后质量价值更高。

经蝶入路垂体腺瘤切除术后并发症与预防的研究进展

垂体腺瘤作为颅内常见的良性肿瘤之一,经蝶入路切除病灶是治疗本病的首选手术方式,但术后多种并发症仍需特别关注,常见的并发症有抗利尿激素变化、垂体功能下降、电解质紊乱、脑脊液漏、感染、颅内出血、视力视野障碍、消化道出血、继发性空蝶鞍综合征等。这些并发症若处理不好可能会严重影响患者术后生存质量。本文收集近年来中英文文献对经蝶入路垂体腺瘤切除术后常见并发症及其防治进行综述,为患者术后并发症制定更好的预防及治疗方案。

经鼻蝶入路神经内镜手术和显微镜手术治疗垂体瘤的临床效果比较

目的 比较经鼻蝶入路神经内镜手术和显微镜手术治疗垂体瘤的临床效果。方法 选取本院收治的45例垂体瘤患者,根据治疗方案的差异将其分为神经内镜组(25例,给予经鼻蝶入路神经内镜手术)和显微镜组(20例,给予经鼻蝶入路显微镜手术)。比较两组的治疗效果。结果 神经内镜组的手术时长、住院时间短于显微镜组,术中出血量少于显微镜组,肿瘤切除情况优于显微镜组(P<0.05)。术后1个月,两组的促肾上腺皮质激素(ACTH)、人生长激素(GH)、促甲状腺激素(TSH)、泌乳素(PRL)水平均明显降低,且神经内镜组低于显微镜组(P<0.05)。术后1个月,两组的视野指数(VFI)、模式标准差(PSD)、平均缺损(MD)均明显改善,且神经内镜组优于显微镜组(P<0.05)。术后1个月,两组的鼻腔鼻窦结局测试-20(SNOT-20)评分均明显降低,生活质量评分均明显升高,且神经内镜组优于显微镜组(P<0.05)。神经内镜组的并发症总发生率明显低于显微镜组(P<0.05)。结论 经鼻蝶入路神经内镜手术治疗垂体瘤可明显提高治疗效果,改善激素水平和视觉功能,并发症发生率更低,值得推广。

神经内镜经鼻蝶入路切除无功能性垂体腺瘤的效果及对视觉功能的影响研究

目的:观察神经内镜经鼻蝶入路切除无功能性垂体腺瘤(NFPA)的效果及对视觉功能的影响。方法:选取2019年6月—2021年6月佳木斯市中心医院内分泌科收治的86例NFPA患者作为研究对象,采用随机数表法分为对照组和观察组,每组各43例。对照组给予显微镜经鼻蝶入路切除术,观察组给予神经内镜经鼻蝶入路切除术。比较两组患者肿瘤切除率、围术期指标、患侧眼球加权视野指数(VFI)、视野平均缺损(MD)、模式标准差(PSD)及并发症发生情况。结果:观察组肿瘤全切除率高于对照组,差异有统计学意义(χ2=4.690,P<0.05)。观察组手术时间长于对照组,观察组术中失血量少于对照组,观察组住院时间短于对照组,差异有统计学意义(t=8.188、18.086、23.352,P<0.05)。术后,两组患者患侧眼球VFI增加,MD、PSD减少,且观察组患侧眼球VFI高于对照组,MD、PSD低于对照组,差异有统计学意义(t=4.715、39.665、24.263,P<0.05)。观察组并发症发生率明显低于对照组,差异有统计学意义(χ2=4.690,P<0.05)。结论:神经内镜经鼻蝶入路切除NFPA可明显提高患者肿瘤全切除率,促进其视觉功能恢复,降低其术后并发症发生率。

大型垂体腺瘤经蝶显微外科切除技术

为探讨大型垂体腺瘤(LPA)经蝶入路、应用显微外科技术治疗的效果 ,作者对 15 2 0例LPA以颅骨X线平片、CT或MRI等影像学检查做出诊断 ,采取经蝶入路、显微镜下进行肿瘤切除术的病例进行了回顾性分析。结果表明 ,12 6 4例 (83 2 % )获全切除 ,195例(12 8% )达次全切除 ,余 6 1例 (4 0 % )系哑铃型或纤维性腺瘤 ,仅获部分切除。手术后 2例 (0 1% )死亡。 12 4 0例进行平均 3 5年随访观察 ,有 12 19例 (98 3% )视力损害获得了恢复 ,仅 2 1例 (1 7% )无变化 ,但未见恶化 ;术前有视野缺损的 12 2 6例 ,术后 1186例 (96 7% )明显改善 ,4 0例 (3 3% )无变化。作者认为 ,除了纤维性或哑铃状LPA外 ,对大型或巨大型垂体腺瘤采取经蝶入路显微外科手术切除是一种安全、有效的方法 。

显微镜下经鼻蝶窦入路垂体瘤切除术的疗效分析

目的探讨经单鼻孔蝶窦入路显微手术切除垂体瘤的疗效。方法 2007年5月～2010年11月在该院住院的28例脑垂体瘤患者均采用显微镜下经单鼻孔蝶窦入路垂体瘤切除术治疗,对其临床资料进行回顾性分析。结果 28例患者中肿瘤全部切除20例,次全部切除8例,手术顺利,术后无死亡、颅内感染和视神经损伤发生。所有患者原有症状均明显缓解,视力障碍和视野缺损者术后均明显改善。8例泌乳素腺瘤患者术前和术后1周的血清泌乳素水平分别为(60.2±14.3)和(12.1±6.8)ng/mL,6例生长激素腺瘤患者术前和术后1周的血清生长激素水平分别为(27.6±5.2)和(8.6±4.0)ng/mL,手术前后比较差异均有显著性(P<0.05);其余激素水平手术前后无明显变化。结论经单鼻孔蝶窦入路显微手术切除垂体瘤是一种安全、有效的手术方法,值得临床推广应用。

神经内镜下经单鼻孔-蝶窦摘除大型垂体腺瘤

目的 探讨内窥镜辅助下单鼻孔 蝶窦入路摘除大型垂体腺瘤 (LPA)的技术方法与疗效。方法 对 2 0 0 3年 12月至 2 0 0 4年 7月 38例LPA采用内窥镜辅助下经单鼻孔 蝶窦入路技术予以切除。结果 33例 (86 .8% )获全切除 ,3例 (7.9% )达次全切除 ,余 2例 (5 .3% )纤维性或哑铃型腺瘤仅获部分切除。无手术后死亡。 31例 (81.6 % )进行平均 3个月随访观察 ,有 2 9例 (93.6 % )视力获得了恢复 ,仅 2例 (6 .4 % )无变化 ,也未见恶化 ;术前有视野缺损的 30例 ,术后 2 8例 (93.3% )恢复 ,2例(6 .7% )有改善。结论 内窥镜辅助下经单鼻孔 蝶窦入路摘除LPA ,具有微侵袭性、视野全景化、术后并发症少等优点 ,是治疗本病的一种安全、有效的方法。

神经导航系统引导单鼻孔蝶窦入路垂体瘤切除术的应用

目的观察神经导航系统引导单鼻孔蝶窦入路垂体瘤切除术的应用效果。方法 32例垂体瘤患者,术前行MRI或CT薄层扫描,将图像资料输入Brain LAB Vector Vision神经导航系统中进行三维重建,据此设计最佳手术入路,并对肿瘤及重要结构作标记;术中在神经导航系统的引导下寻找蝶窦前壁、鞍底、颈内动脉、海绵窦和斜坡等结构,切除肿瘤。结果 32例均在神经导航引导下经鼻蝶入路顺利到达肿瘤部位,注册误差0.3～2.5 mm;肿瘤全切除24例,次全切除6例,大部切除2例;术后26例症状有不同程度的改善,6例无变化,无严重并发症出现。结论神经导航引导单鼻孔蝶窦入路垂体瘤切除术定位准确、肿瘤全切除率高、并发症少。

显微经蝶窦入路切除垂体腺瘤术中垂体功能保护技术探讨

目的:探讨垂体腺瘤经蝶窦手术中垂体柄和垂体组织的辨认与保护,以进一步改善垂体腺瘤的手术疗效。方法:中南大学湘雅医院神经外科2010年10月至2012年9月单鼻孔经鼻腔蝶窦入路显微手术切除肿瘤并经病理确诊的51例垂体腺瘤,通过术前影像学资料和术中显微解剖,仔细辨认正常腺垂体、垂体柄、神经垂体与病变组织的关系,尽可能切除垂体腺瘤组织,达到垂体功能的保护及减少术后并发症。结果:37例(72.5%,37/51)肿瘤全切除,12例(23.5%,12/51)肿瘤次全切除,2例(3.9%,2/51)肿瘤大部分切除。术中对正常垂体组织及垂体柄均予以完整保留。激素测定示手术对游离三碘甲状腺原氨酸(free triiodothyronine,FT3),促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)的影响小,而对于游离四碘甲状腺原氨酸(free tetraiodothyronine,FT4),促甲状腺激素(thyroid stimulating hormone,TSH)术后及随访的结果则均有明显的改善。男性睾酮测定值术前术后无明显变化(以上结果均在无激素替代治疗作用下测定)。术后并发症主要有:尿崩患者5例(9.8%,5/51),无永久性尿崩;电解质紊乱(主要指低钠血症)患者17例(33.3%,17/51);术后脑脊液鼻漏和颅内感染患者各1例(2.0%,1/51)无围手术期死亡患者。结论:显微经蝶窦手术可以实现垂体腺瘤(包括侵犯到海绵窦内肿瘤)的有效切除;显微经蝶窦手术中术者应对正常垂体、垂体柄及病变组织等准确辨识,这样才能达到保留和恢复垂体功能的治疗目标。

经单鼻孔蝶窦入路切除垂体腺瘤

目的 介绍经单鼻孔蝶窦入路切除垂体腺瘤的显微手术技术以及并发症的处理。方法 所有病人均经单鼻孔蝶窦入路切除肿瘤。先扩张术侧鼻孔，将扩鼻器直接插入鼻孔深处直抵蝶窦前壁，扩张后鼻中隔被完整地推向对侧。在手术显微镜下，分离蝶窦前壁的粘膜，然后凿除蝶窦前壁骨质，进入蝶窦。术后31．5％接受放疗。结果 本组未发生严重永久性并发症，无死亡。412例（72．7％得到随访，随访时间3个月～8年，平均3年6个月。72．1％治愈，20．1％控制，7．8％复发。 结论 该入路损伤小，安全，并发症少，省时， 简便易行，适用于切除绝大多数垂体腺瘤。

二次经鼻蝶入路垂体瘤显微切除术45例

目的探讨经鼻蝶入路二次手术切除垂体腺瘤的手术方法和技巧,并总结术后通过综合治疗增加缓解率及预防并发症的经验。方法回顾性分析同济医院神经外科2005年1月至2010年11月二次经鼻蝶入路垂体瘤手术治疗的45例患者的临床资料,对手术切除程度,术后视力和内分泌的变化及并发症,术后综合治疗方法等进行总结和分析。结果患者全切加次全切除率达到81.3%,术前视力有障碍者术后好转率100%,功能性垂体腺瘤患者40.9%恢复正常,余患者均有不同程度好转。无死亡病例,无严重并发症病例出现。结论对于垂体瘤复发或残余患者,若存在手术适应证,再次经鼻蝶手术依旧是疗效最确切且相对十分安全的治疗手段,可作为治疗首选,配合药物和(或)放疗的综合治疗将能进一步提高疗效。

单鼻孔蝶窦入路显微切除垂体腺瘤

目的:探讨单鼻孔蝶窦入路显微手术治疗垂体腺瘤的技术方法和疗效。方法:对2002年12月至2005年1月44例垂体腺瘤患者采用经单鼻孔蝶窦直接入路显微手术技术予以切除。结果:27例(61.4%)患者腺瘤获全切除,13例(29.5%)次全切除,4例(9.1%)部分切除,无手术死亡。对33例(75%)患者进行平均14个月随访,20例(20/22)头痛消失或减轻;23例(23/25)视力、视野障碍显著改善,2例视力、视野障碍无改善;8例(8/10)肢端肥大症明显减轻;9例(9/12)溢乳停止;9例(9/14)月经恢复。结论:单鼻孔蝶窦入路显微外科手术最大限度地利用了鼻腔的自然间隙,具有入路直接、创伤轻微、手术时间短、并发症少等优点,是微创治疗垂体腺瘤的一种安全有效的方法。

经蝶辅助内窥镜切除大型垂体腺瘤

目的 介绍和评价 1993年至 2 0 0 2年内经蝶入路显微外科辅助内窥镜切除 138例大型垂体腺瘤的手术操作技术及经验。方法 138例大型垂体腺瘤 ,男性 6 6例 ,女性 72例。手术采用经蝶显微外科辅助内窥镜。结果 本组全切肿瘤 10 9例 ,占 78.9%。结论 经蝶显微手术仍是一种较为实用手术 ,显微外科辅助内窥镜可提高大型垂体腺瘤的全切率。