Charalampaki P, Reisch R, Ayad A, Welschehold S, Conrad J, Wüster C
Department of Neurosurgery, Johannes-Gutenberg University Mainz, Mainz, Germany.
Minim Invasive Neurosurg. 2006 Apr;49(2):93-7. doi: 10.1055/s-2006-932170.
Neuronavigation is a commonly used technology that provides continuous, three-dimensional information for the precise localization of and surgical trajectory to brain lesions. This study was performed to evaluate the role that navigation can play in assisting microsurgical transsphenoidal surgery for precise localization and removal of recurrent pituitary tumours while simultaneously preserving pituitary gland function.
During a 6-month period -- July 2004 until December 2004 -- 9 patients with recurrent pituitary tumours (5 female and 4-male) were treated with navigation-guided transsphenoidal microsurgical resection. Surgery was performed via a paraseptal or endonasal transsphenoidal approach. The navigation system Vector Vision (Brain Lab, Heimstetten, Germany) allowed precise localization of the tumours (7 hormonal active and 2 inactive microadenomas) in respect to the pituitary gland, the carotid arteries and the cavernous sinus.
Postoperative MRI investigations of the 9 patients treated with image-guided transsphenoidal microsurgery, showed total tumour removal in 7 (77 %) patients and subtotal removal in 2 patients (23 %). One patient (11 %) developed a cerebral spinal fluid (CSF) leak and was treated conservatively. One patient (11 %) had preoperative insufficiency of the corticotrope axis which remained unchanged postoperatively. Of the remaining 8 patients who did not have preoperative endocrinological disturbance, only one (12 %) developed postoperative insufficiency of the corticotrope axis. Out of the 7 patients with hormone active tumours, 5 (72 %) patients showed no more postoperative hormonal activity.
Microneurosurgical transsphenoidal techniques combined with image-guided systems can precisely define the localization and removal of lesions in the sella region with respect to the margins of important anatomical structures in the neighbourhood and the endocrinological functionality of the pituitary gland.
神经导航是一种常用技术，可为脑病变的精确定位和手术路径提供连续的三维信息。本研究旨在评估导航在辅助显微外科经蝶窦手术中对复发性垂体肿瘤进行精确定位和切除，同时保留垂体功能方面所起的作用。
在2004年7月至2004年12月的6个月期间，对9例复发性垂体肿瘤患者（5例女性，4例男性）进行了导航引导下的经蝶窦显微手术切除。手术通过鼻中隔旁或鼻内经蝶窦入路进行。Vector Vision导航系统（德国海姆斯泰滕的Brain Lab公司）能够相对于垂体、颈动脉和海绵窦精确地定位肿瘤（7例激素活性微腺瘤和2例无功能微腺瘤）。
对9例接受影像引导经蝶窦显微手术治疗的患者进行术后MRI检查，结果显示7例（77%）患者肿瘤完全切除，2例（23%）患者肿瘤次全切除。1例患者（11%）发生脑脊液漏，经保守治疗。1例患者（11%）术前存在促肾上腺皮质激素轴功能不全，术后无变化。其余8例术前无内分泌紊乱的患者中，只有1例（12%）术后出现促肾上腺皮质激素轴功能不全。在7例激素活性肿瘤患者中，5例（72%）患者术后激素活性消失。
显微神经外科经蝶窦技术与影像引导系统相结合，能够相对于周围重要解剖结构的边界以及垂体的内分泌功能精确定义鞍区病变的定位和切除。
