Cappabianca P, Alfieri A, Colao A, Cavallo L M, Fusco M, Peca C, Lombardi G, de Divitiis E
Department of Neurosurgery, Federico II University, School of Medicine, Naples, Italy.
Minim Invasive Neurosurg. 2000 Mar;43(1):38-43. doi: 10.1055/s-2000-8814.
Despite a good cure rate after surgery, the recurrence rate in pituitary adenomas is globally high. The decision making in such cases can be problematic for the nature of the lesion, for the anatomic structures involved, for the different pharmacological, surgical, radiotherapeutic and radiosurgical options nowadays available. In the perspective of an improvement and refinement of the surgical procedure an endoscopic endonasal transsphenoidal approach to the pituitary was recently adopted in the Neurosurgical Department of the University of Naples. Its minimal invasiveness and its wider and direct anatomic control of the operative field has allowed a faster, greater and safer potential of tumour excision, with respect of the sphenoid, sellar and parasellar structures. The authors have examined the advantages provided by this technique in 12 patients with recurrent pituitary adenomas and in 2 craniopharyngiomas already treated via a transnasal transsphenoidal approach (TTA), where the anatomy of surgical field had been distorted by the first operation or the radiation therapy. They conclude that the endoscopic transsphenoidal re-operation might be considered the procedure of choice in case of recurrences and its easiness in such conditions could favour its larger use, before other more aggressive therapeutic solutions.
尽管垂体腺瘤手术后治愈率较高，但全球范围内其复发率仍居高不下。鉴于病变的性质、所涉及的解剖结构以及目前可用的不同药物、手术、放射治疗和放射外科治疗选择，此类病例的决策可能存在问题。为了改进和完善手术方法，那不勒斯大学神经外科最近采用了经鼻内镜经蝶窦入路治疗垂体疾病。与蝶窦、鞍区和鞍旁结构相比，其微创性以及对手术视野更广泛和直接的解剖控制，使得肿瘤切除具有更快、更彻底和更安全的潜力。作者研究了该技术在12例复发性垂体腺瘤患者和2例已经通过经鼻经蝶窦入路（TTA）治疗的颅咽管瘤患者中的优势，这些患者的手术视野解剖结构因首次手术或放射治疗而扭曲。他们得出结论，对于复发情况，内镜经蝶窦再次手术可被视为首选手术方式，而且在这种情况下其操作简便可能有利于在采用其他更激进的治疗方案之前更广泛地应用该手术。
