Shen C C, Wang Y C, Hua W S, Chang C S, Sun M H
Department of Neurosurgery, Taichung Veterans General Hospital, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 2000 Apr;63(4):301-10.
The traditional transsphenoidal approach for pituitary surgery can be performed via transnasal, transseptal, or sublabial routes through unilateral or bilateral nostrils. It requires wide mucosal and septal dissection and postoperative nasal packing. Endoscopic surgery has been widely used because it allows excellent visualization with minimal invasion. Recently, it has also been applied to pituitary surgery.
From January, 1997 to February, 1999, 40 patients with pituitary adenomas underwent the transsphenoidal approach using a rigid endoscope via one nostril. Among the 40 cases, 18 were prolactinomas, seven were growth hormone-secreting adenomas and 15 were nonfunctional adenomas.
After surgery, complete resolution or improvement of symptoms and restoration of normal hormone levels were achieved in 16 patients with prolactinomas, five with growth hormone-secreting adenomas and 12 with nonfunctional macroadenomas. One patient with a recurrent microprolactinoma needed a second operation to remove the cavernous portion of the tumor. Another male patient with a macroprolactinoma who experienced galactorrhea and gynecomastia showed improvement of clinical symptoms after the operation. Two patients with residual growth hormone-secreting macroadenomas in the cavernous sinus needed Sandostatin treatment. Three patients with nonfunctional macroadenomas underwent nearly total resection leaving residual tumor in the cavernous sinus, which then required adjuvant radiotherapy. No complications related to this approach were encountered in the patients during the follow-up period.
Endonasal transsphenoidal endoscopic surgery can be employed for treating pituitary tumors without septal or sublabial complications. Postoperative suffering was reduced and hospitalization was shortened by this mini-invasive procedure. This surgical procedure can be used for both microadenomas and macroadenomas.
垂体手术的传统经蝶窦入路可通过经鼻、经鼻中隔或经唇下途径，经单侧或双侧鼻孔进行。它需要广泛的黏膜和鼻中隔剥离以及术后鼻腔填塞。内镜手术因其能在微创的情况下实现极佳的视野而被广泛应用。近来，它也已应用于垂体手术。
1997年1月至1999年2月，40例垂体腺瘤患者经单鼻孔使用硬质内镜行经蝶窦入路手术。40例患者中，18例为泌乳素瘤，7例为生长激素分泌型腺瘤，15例为无功能腺瘤。
术后，16例泌乳素瘤患者、5例生长激素分泌型腺瘤患者和12例无功能大腺瘤患者症状完全缓解或改善，激素水平恢复正常。1例复发性微泌乳素瘤患者需要二次手术切除肿瘤的海绵窦部分。另1例患有大泌乳素瘤且有溢乳和男子乳腺发育的男性患者术后临床症状改善。2例海绵窦内有残留生长激素分泌型大腺瘤的患者需要使用善龙治疗。3例无功能大腺瘤患者行近全切除，海绵窦内残留肿瘤，随后需要辅助放疗。随访期间患者未出现与该入路相关的并发症。
鼻内经蝶窦内镜手术可用于治疗垂体肿瘤，无鼻中隔或唇下并发症。这种微创手术减少了术后痛苦，缩短了住院时间。该手术方法可用于微腺瘤和大腺瘤。
