【摘要】 目的总结单纯神经内镜下经鼻蝶窦入路切除垂体腺瘤的经验及体会。方法对36例垂体腺瘤病人行单纯神经内镜肿瘤切除术,其中3例辅以神经导航。4例侵犯海绵窦,3例为复发性垂体腺瘤。结果肿瘤全切除28例,次全切(>80%)5例,大部切除3例;手术时间1￣3.5h,平均2h。手术后平均住院4.6d。无死亡,无视神经损伤、脑脊液鼻漏发生;1例手术后3个月证实慢性蝶窦炎症;13例术后出现一过性多尿,2例多尿持续3￣6个月。随访1个月￣2.5年,原有症状均有所改善,19例视力受损病人中改善18例,28例激素水平异常增高病人中降至正常19例。2例手术后接受了γ-刀治疗,15例手术后3个月行普通放疗。1例术后1年后复发,再次行导航辅助下内镜手术。结论神经内镜经鼻蝶窦入路切除垂体腺瘤疗效满意,损伤小;神经导航提供实时定位,可选择性采用。更多还原

【Abstract】 Objective To report our experience of endoscopic endonasal transsphenoidal surgery for pituitary adenomas in 36 patients. Methods Thirty-six patients underwent endoscopic endonasal transsphenoidal surgery for pituitary adenomas, in whom neuronavigation system was used in 3 cases. Four patients had invasive macroadenomas involving the cavernous sinus and 3 recurrent pituitary adenomas. Results Total tumor resection was achieved in 28 cases, subtotal in 5, and partial in 3. The operation duration were from 1 to 3.5 hours, with an average of 2 hours. The postoperative hospitalization averaged 4.6 days. No post-operative death, optic nerve injury and cerebrospinal rhinorrhea were noted. Chronic sphenoidal sinusitis was confirmed in 1 case after 3 months. Thirteen cases presented temporary polyuria, 2 of whom went on for 3-6 months after the operation. Follow-up ranged from 1 month to 2.5 years, deterioration of visual acuity was ameliorated in 18 out of 19 cases. In 28 patients with abnormally high level of hormone, 19 recovered to normal level. 2 patients underwent γ-knife after operation and 15 received radiation therapy 3 months after the operation. Recurrence occurred in 1 case in one year and endoscopic reoperation assisted by neuronavigation was performed. Conclusions Endoscopic transsphenoidal surgery provides an effective and less invasive therapy for pituitary adenomas. Neuronavigation system could provide real-time localization and could be a selective assistance to the surgery.更多还原