摘要
目的探讨经颅手术联合经鼻蝶入路神经内镜手术治疗巨大(>4 cm)侵袭性垂体腺瘤的疗效。方法回顾性分析2017年9月~2023年3月双镜联合手术治疗的18例巨大侵袭性垂体腺瘤的临床资料,观察术后肿瘤切除率、激素缓解情况以及颅内感染、术区出血等并发症发生情况。结果肿瘤全切除14例(77.8%),次全切除4例(22.2%)。手术时间平均(5.2±1.4)h。术后内分泌复查:术前泌乳素增高的11例中,术后恢复正常8例,无明显变化3例;术前1例促肾上腺皮质激素增高,术后恢复正常。术后出现肾上腺功能减退2例(11.1%)、暂时性尿崩症2例(11.1%)、远隔部位急性硬膜外血肿1例、脑脊液漏1例,无颅内感染、术区出血。术后随访3~24个月,平均(10.1±9.1)个月;1例次全切除术后复发(肿瘤直径约1 cm),经γ刀治疗后未见明显生长,未再次手术治疗。头痛缓解率为78.6%(11/14),视力及视野改善率为85.7%(12/14)。结论经颅显微镜下手术联合经鼻蝶入路神经内镜手术治疗巨大侵袭性垂体腺瘤是安全、有效、可行的。巨大侵袭性垂体腺瘤经术前充分评估难以从单一入路切除时,可选择双镜联合手术,争取一期安全切除肿瘤。
Objective To investigate the efficacy of transcranial surgery(TCS)combined with transsphenoidal endoscopic surgery(TSES)for patients with giant(>4 cm)invasive pituitary adenoma.Methods The clinical data of 18 patients with giant invasive pituitary adenoma,who underwent TCS combined with TSES from September 2017 to March 2023,were retrospectively analyzed.The postoperative tumor resection rate,hormone remission,intracranial infection,operative area bleeding,and other complications were observed.Results Total tumor resection was achieved in 14 patients(77.8%),and subtotal in 4(22.2%).The average operation time was(5.2±1.4)hours.Postoperative endocrine reexamination showed that of 11 patients with increased prolactin before surgery,8 patients returned to normal and 3 did not change significantly after surgery.Additionally,one patient with increased adrenocorticotropic hormone before surgery returned to normal after the procedure.Adrenal insufficiency occurred in 2 patients(11.1%),temporary diabetes insipidus in 2(11.1%),acute epidural hematoma at a remote site in 1,and cerebrospinal fluid leakage in 1.There were no intracranial infection or operative area bleeding.Follow-up ranged from 3 months to 24 months with an average of(10.1±9.1)months.One patient recurred after subtotal resection(tumor diameter approximately 1 cm),which was subsequently treated using gamma knife therapy without any significant growth thereafter.The headache remission rate was 78.6%(11/14),and the improvement rate for vision and visual field reached up to 85.7%(12/14).Conclusions TCS combined with TSES is a safe,effective,and feasible approach for treating giant invasive pituitary adenomas.When a giant invasive pituitary adenoma is difficult to be resected from a single approach after adequate preoperative evaluation,combined surgery can be selected to achieve one-stage safe tumor resection.
作者
孙霄
冯思哲
梁国标
韩松
孙晓宇
白杨
李心宁
王格宇
孙瑛玮
SUN Xiao;FENG Si-zhe;LIANG Guo-biao;HAN Song;SUN Xiao-yu;BAI Yang;LI Xin-ning;WANG Ge-yu;SUN Ying-wei(Department of Neurosurgery,The General Hospital of Northern Theater Command,110016)
出处
《中国临床神经外科杂志》
2023年第9期545-548,共4页
Chinese Journal of Clinical Neurosurgery
基金
辽宁省科学技术计划项目(2021JH2/10300116,2022JH2/101500023)。
