摘要
目的探讨经颅切除巨大侵袭型垂体腺瘤手术入路的选择与显微手术策略。方法收集2008年1月至2010年12月我院收治的27例巨大垂体腺瘤临床资料,其中经额下入路4例、经翼点入路和改良翼点入路6例、经前纵裂入路5例、经额下-胼胝体穹隆间联合入路2例、经额下-纵裂-蝶骨平台联合入路3例、经额下-纵裂联合入路5例和额部纵裂-终板2例,术中经鞍区不同解剖腔隙切除肿瘤,注意保护供应垂体炳﹑视神经﹑视交叉和下丘脑的穿支动脉。结果 27例中肿瘤全切除19例、次全切除8例。视力好转19例,尿崩和电解质紊乱13例,经治疗得到控制;8例下丘脑功能损伤,无死亡病例。所有病例随访6～32个月,复发6例。结论合理的手术入路是巨大垂体腺瘤手术成功的前提,娴熟的显微手术技术可避免术中损伤、提高肿瘤的全切除率以及减少术后并发症的关键。
Objective To introduce the surgical approach and transcranial management operative strategies for microsurgical resection of the giant invasive pituitary adenoma.Methods To analyze retrospectively the clinic data of 27 patients with giant pituitary adenoma were treated surgically by our neurosurgeons from January 2008 to December 2010.4 patients were operated via the subfrontal approach,the pterional and nodified pterional approach in 6,the anterior interhemispheric approach in 5,combined transsubfrontal-callosal-interforniceal approach in 2,the subfrontal-interhemispheric combined with sphenoidal platfoem-sinus approach in 3,the subfrontal-interhemispheric approach in 5,and transfrontal interhemispheric combined with subfrontal in 2.The tumors were removed by employing microsurgical technique via the parachiasmal opticocarotid and carotidotentorial spaces in sellar region and by opening the lamina terminals.Much attention was given to the preservation of perforating arteries from the interal carotid artery,anterior and posterior communicating arteries and arterior choroidal artery to the stalk,optic nerve,optic chiasm and hypothalamus.Results The tumors were total removed in 19 cases,subtotal in 8 cases.8 of them had hypothalamic dysfunction performance,visal acuity showed improvement in 19cases,biabetes insipidus or electrolytic derangement was noted in 13 cases.There were no post-operative deaths.All patients were followed up ranged from 6 to 32 months,recurrence in 6 cases.Conclusion A reasonable surgical approach is a prerequisite for the giant invasive pituitary adenoma surgery,acquaiantance with anatomy of sellar region and protection of the vital structres,approprite operative strategies and skilled microsurgical technique is the key to tumor excision and reducing post-operative complications,The tumor could be removed with high percentage of total resection under the direct exposure.
出处
《脑与神经疾病杂志》
2013年第4期293-297,共5页
Journal of Brain and Nervous Diseases
关键词
经颅入路
垂体腺瘤
手术入路
显微外科
Transcranial approach
Pituitary adenoma
Surgical approach
Microsurgery
