摘要
目的探讨神经导航在内镜下经单鼻孔切除伴有甲介、鞍前型蝶窦变异的垂体腺瘤手术中的应用。方法回顾性分析我院自2004年10月至2006年8月应用神经导航技术对伴有甲介、鞍前型蝶窦变异的垂体腺瘤进行的10例内镜下单鼻孔手术。其中生长激素腺瘤3例,高泌乳素腺瘤4例,促肾上腺皮质激素腺瘤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,甲介型5例,鞍前型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6～24个月,术前症状(视力受损、尿崩症)均在术后消失,血液、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。结论对于伴有甲介、鞍前型蝶窦变异的垂体腺瘤手术,应用神经导航辅助内镜能确保术中定位准确,术术野大而直观,有利于切除肿瘤,并保护周围重要结构。
Objective To investigate the application of neuronavigation-assisted endoscope in resection of pituitary adenomas accompanied with variations of turbinate or pre-sellar sphenoid sinuses by the trans-single nostril and transsphenoidal approach. Methods A retrospective study was performed on 10 patients undergoing resection with neuronavigation-assisted endoscope of their pituitary adenomas accompanied with variations of turbinate or pre-sellar sphenoid sinuses by the trans-single nostril and transsphenoidal approach during Oct., 2004 and Aug., 2006 in our hospital. Among the 10 cases, 3 were diagnosed as growth hormone-secreting pituitary adenomas, 4 prolactin-secreting pituitary adenomas, 1 adrenocorticotropic hormone-secreting pituitary adenoma and 2 nonfunctional pituitary adenomas. Results of coronal CT scans and X-ray plain films of the sphenoid sinuses indicated that 5 cases had turbinate sphenoid sinuses and the other 5 had pre-sellar sphenoid sinuses. Preoperative cerebral CT and MRI and intraoperative neuronavigational localization performed, adenomas were removed under the endoscope by the trans-single nostril and transsphenoidal approach. Results After 6 to 24 months follow-up study, the preoperative symptoms of visual impairment and diabetes insipidus vanished after the surgery, and the blood and endocrine indices were all within the normal range. Rechecking MRI for 8 cases undergoing follow-up study over 1 year found no adenoma residues or recurrence. No case showed the postoperative complications of intracranial hemorrhage, vision or visual field disturbances, diabetes insipidus, cerebrospinal fluid leakage or intracranial infection. Conclusion Neuronavigation-assisted endoscope in resection of pituitary adenomas accompanied with variations of turbinate or pre-sellar sphenoid sinuses may ensure the accuracy of intraoperative localization, and the greatness and clearness of intraoperative visual field. Advantages of the procedure are helpful for the resection of tumors, without damage to the peripheral vital organs or tissues.
出处
《中华神经医学杂志》
CAS
CSCD
2007年第10期1012-1014,共3页
Chinese Journal of Neuromedicine
基金
福建省厦门市科技计划重点项目(WSK0519)
关键词
神经导航
内镜
垂体腺瘤
蝶窦变异
经蝶入路
Neuronavigation
Endoscope
Pituitary adenoma
Variations of sphenoid sinuses
Transsphenoidal approach
