摘要
目的探讨神经导航在内镜下经单鼻孔切除伴有蝶窦复杂变异的垂体瘤手术中的应用。方法回顾性分析我院2005年1月至2006年8月,应用神经导航技术对伴有蝶窦复杂变异的垂体瘤进行内镜下单鼻孔手术11例。其中GH腺瘤3例,PRL腺瘤5例,ACTH腺瘤1例,无功能性腺瘤2例。蝶窦冠状CT及蝶窦X线平片提示蝶窦形态,多隔腔3例(均>4腔,其中伴横隔腔1例),鞍前型3例,甲介型5例。术前行头部CT、MRI扫描,术中神经导航定位,在内镜下经单鼻孔切除肿瘤。结果术后随访3～25个月,术前症状(视力受损,尿崩症)均在术后消失,随访血内分泌指标均在正常范围内。术后随访1年以上的病例(8例)复查MRI均提示未见肿瘤残留或复发。术后所有病例均无出现颅内出血,视力,视野障碍,尿崩,脑脊液漏,颅内感染等并发症。结论对于伴有蝶窦复杂变异,尤其对于甲介型和鞍前型的垂体瘤手术,应用神经导航辅助内镜能确保术中定位准确,术野大且直观。有利于切除肿瘤,并保护周围重要结构。
Objective To investigate the applications of endoscopic neuronavigation into trans--sphenoidal resection for pituitary adenoma accompanied by variations of sphenoid sinuses. Methods The retrospective study was performed on eleven cases with pituitary adenoma accompanied by variations of sphenoid sinuses during the period Jan. 2005-Aug. 2006 in our hospital. 11 cases were all subjected to tumor resection through trans--sphenoidal approach under endoscopic neuronavigation. Among those 11 cases, three cases was diagnosed with GH adenoma, five cases were diagnosed with PRL adenoma, a case with ACTH adenoma and two cases with nonfunctional adenoma. The results from coronal CT scans and X--ray films of the sphenoid sinuses suggested that three cases showed multiseptation sinuses sphenoid（All of three cases had more than four sinuses, and one of them hadsinuses with transverse septa. ）, three cases showed anti--saddle adenoma and five cases showed conchoidal sphenoid adenoma, brain CT scanning and MR were performed before surgery. Tumor resection through trans--sphenoidal approach were performed under the guidance of endoscopic neuronavigation. Results After three to twenty five months follow--up study on those patients, we found that all of the preoperative symptoms, such as impairment of the eyesight and diabetes insipidus, have been disappeared after operation. The endocrine indexes in blood are all within the nomal range. The MR. results from 8 cases after one year follow--up study indicated no residual or recurrent tumor. No case showed any of postoperative complications, such as intracalvarium bleeding, impairment of visual sight or visual field, diabetes insipidus, leakage of cerebralspinal fluid and intracranial infection. Conclusion The cooperative application of nenronavigate endoscopy into the surgery for pituitary adenoma with variations of sphenoid sinuses, can help to remove the tumor more easily without damage the periphery vital organs. The advantages of this procedure are that we can localize the target surgery area more accurately and we may get a clearer visual field when doing surgery.
出处
《立体定向和功能性神经外科杂志》
2007年第4期209-212,共4页
Chinese Journal of Stereotactic and Functional Neurosurgery
基金
福建省厦门市科技计划重点项目(编号:WSK0519)
关键词
神经导航
内镜
垂体瘤
蝶窦变异
经蝶入路
Nenronavigation
Endoscope
Pituitary adenoma
Variations of sphenoid sinuses
Transsphenoidal approach
