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目的探讨采用经单鼻孔蝶窦路径、神经内镜辅助摘除垂体肿瘤(PNs)的手术技术并评价其疗效。方法将2003年12月至2004年9月入住本科的连续78例PNs患者行磁共振成像(MRI)或CT扫描检查,显示鞍区肿瘤并压迫视神经与视交叉。均采用经单鼻孔蝶窦路径、在神经内镜辅助下摘除PNs。结果71例患者(91.0%)肿瘤获全摘除,5例(6.4%)达次全切除,余2例(2.6%)纤维性肿瘤仅获部分切除。本组术后无死亡。对67例进行平均3个月的随访,64例(95.5%)视力迅速恢复,余3例(4.5%)亦有好转;术前有视野缺损的62例,术后60例(96.8%)恢复,另2例(3.2%)有改善。结论经单鼻孔蝶窦路径在神经内镜下切除PNs,是一种有效的微侵袭手术方法,术中将内镜变换角度,有助于安全而彻底地切除肿瘤。
Objective To explore the surgical technique of neurosurgery for the removal of pituitary tumors (PNs) via single nostril sphenoid sinus pathways and to evaluate its efficacy. Methods A total of 78 consecutive patients with PNs admitted to our department from December 2003 to September 2004 underwent magnetic resonance imaging (MRI) or computed tomography (CT) scan. The tumors showed sellar area and oppression of optic nerve and optic chiasm. All through the single nostril sphenoid path, with the help of neuroendoscope PNs removed. Results Totally 71 cases (91.0%) had complete tumor removal, 5 cases (6.4%) had subtotal total resection, and the remaining 2 cases (2.6%) had partial resection. No death after surgery in this group. Of the 67 patients who were followed up for an average of 3 months, visual acuity recovered rapidly in 64 (95.5%) patients and visual acuity recovered rapidly in 3 (4.5%) patients. Sixty two patients (62.8% , And the other two cases (3.2%) improved. Conclusion The single nostril sphenoid path resection of PNs by endoscopic neurosurgery is an effective microinvasive surgical method. The intraoperative endoscopic transformation angle helps to safely and thoroughly remove the tumor.