目的探讨在神经导航辅助下采用个体化入路切除大型侵袭性垂体瘤的手术方法及效果。方法 2004-2009年收治的HardyⅣ级以上大型侵袭性垂体瘤患者17例,男7例,女10例,年龄22~78(39.8±9.2)岁,术前均在神经导航辅助下进行个体化的入路设计,采用翼点入路、额下硬膜外入路、经蝶窦入路以及两两联合入路,在神经导航的指引下,充分利用自然解剖间隙,切除向多方向侵袭生长的垂体瘤。术后3d复查头颅CT,术后1~3个月复查头颅MRI,随访6~72个月,综合影像学检查及临床结果评价手术切除范围及手术疗效。结果术后复查显示全切15例,次全切1例,大部切除1例;术后短暂性尿崩8例,电解质紊乱2例,脑脊液漏2例,嗅觉减退2例,视力损害加重1例,术侧动眼神经及外展神经功能障碍l例,枕顶远隔部位硬膜外血肿1例。无死亡病例。结论根据肿瘤生长方向采用神经导航辅助下的个体化手术入路,可帮助术者了解入路路径中的血管分支及神经,从而选择最佳入路,有助于提高大型侵袭性垂体瘤的全切率和安全性,降低伤残率。 Objective To explore the surgical approach and effect of excision of large invasive pituitary tumor with the help of neuro-navigation. Methods A total of 17 patients with large invasive pituitary adenomas above grade Hardy Ⅳ were recruited in 2004-2009. There were 7 males and 10 females, aged from 22 to 78 (39.8 ± 9.2) years. All patients underwent preoperative neuroimaging with individualized Approach design, the use of pterional approach, the amount of epidural approach, transsphenoidal approach and the combined approach of two in the guidance of neurological navigation, make full use of the natural anatomical gap, removal of multi-directional invasion and growth Pituitary tumor. The head CT was reviewed after 3 days and the head MRI was reviewed 1 to 3 months after operation. The follow-up ranged from 6 to 72 months. The scope of the resection and the curative effect were evaluated by comprehensive imaging examination and clinical results. Results The results of postoperative resection showed that 15 cases were totally excised, 1 case was subtotally resected and 1 case was mostly resected. There were 8 cases of transient diabetes insipidus, 2 cases of electrolyte disturbance, 2 cases of cerebrospinal fluid leakage, 2 cases of olfactory loss, and 1 case of visual impairment Cases, lateral oculomotor nerve and abducens nerve dysfunction in 1 case, 1 case of distal epidural hemorrhage in the distal vertex. No deaths. Conclusion According to the direction of tumor growth, neuro-navigation-assisted individualized surgical approach can help the surgeon to understand the blood vessel branches and nerves in the approach pathways, so as to select the best approach and help improve the overall invasion of large invasive pituitary tumors Cut rate and safety, reduce the disability rate.