Rudnik Adam, Zawadzki Tomasz, Wojtacha Maciej, Bazowski Piotr, Zubgałuszka-Ignasiak Beata, Duda Izabela
Katedra i Klinika Neurochirurgii, Slaska Akademia Medyczna w Katowicach, ul. Medyków 14, 40-752 Katowice, Poland.
Neurol Neurochir Pol. 2005 Jan-Feb;39(1):17-23; discussion 24-5.
The aim of this study is to present a new endoscopic transnasal transsphenoidal method of surgical treatment of pituitary adenomas and to evaluate the results and complications of the method.
From October 2001 to June 2003 in the Department of Neurosurgery of the Medical University of Silesia in Katowice 88 operations of pituitary adenomas were performed using the transnasal transsphenoidal endoscopic method. The group of patients consisted of 50 females and 38 males. The youngest patient was 11 years old and the oldest was 79 years old. Patients were operated on using the 4-mm diameter endoscope with 0- and 30-degree angled lenses, using a method of operation according to Jho and Carrau with own modifications. At the time of surgery the operation team included 2 neurosurgeons, an anesthesiologist and a laryngologist.
In the group of 51 nonfunctioning adenomas, in 32 cases we obtained the total removal of the tumor, which amounts to 63%. Among 37 of hyperfunctioning adenomas there were 11 prolactinomas, 19 GH secreting adenomas and 7 ACTH secreting adenomas. In all cases of prolactinomas the tumor was removed totally and in the cases of GH secreting adenomas and ACTH secreting adenomas the total removal of the tumor was performed in 58% and 86% of the cases, respectively. One patient within our group died after the operation. It was the patient with a huge nonfunctioning macroadenoma, with hydrocephalus and preoperative disturbances of consciousness. The permanent diabetes insipidus occurred in 2 cases, which amounts to 2.3% of all operated patients. In this group we noticed the intraoperative CSF leakage in 20 cases but we did not observe the postoperative CSF leakage or any rhinological complications.
The endoscopic transnasal transsphenoidal approach is an efficient method of surgical treatment of pituitary adenomas. The advantage of this method is low invasiveness and a small number of serious complications.
本研究旨在介绍一种经鼻蝶窦内窥镜手术治疗垂体腺瘤的新方法，并评估该方法的治疗效果及并发症。
2001年10月至2003年6月期间，在卡托维兹西里西亚医科大学神经外科，采用经鼻蝶窦内窥镜方法对88例垂体腺瘤患者进行了手术。患者组包括50名女性和38名男性。最年轻的患者11岁，最年长的79岁。使用直径4毫米、带有0度和30度角镜头的内窥镜，采用Jho和Carrau的手术方法并加以自身改良对患者进行手术。手术时，手术团队包括2名神经外科医生、1名麻醉师和1名耳鼻喉科医生。
在51例无功能性腺瘤患者组中，32例实现了肿瘤全切，全切率为63%。在37例功能性腺瘤中，有11例催乳素瘤、19例生长激素分泌型腺瘤和7例促肾上腺皮质激素分泌型腺瘤。所有催乳素瘤患者的肿瘤均被全切，生长激素分泌型腺瘤和促肾上腺皮质激素分泌型腺瘤的全切率分别为58%和86%。本组中有1例患者术后死亡。该患者为巨大无功能性大腺瘤，伴有脑积水和术前意识障碍。永久性尿崩症发生2例，占所有手术患者的2.3%。本组中20例患者术中出现脑脊液漏，但未观察到术后脑脊液漏或任何鼻科并发症。
经鼻蝶窦内窥镜入路是治疗垂体腺瘤的一种有效手术方法。该方法的优点是侵袭性低且严重并发症少。
