Kobayashi Nobuyuki, Watanabe Eiju, Ichimura Keiichi
Department of Neurosurgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-city, Tochigi 329-0498, Japan.
No Shinkei Geka. 2006 Sep;34(9):907-16.
Endoscope-assisted transnasal approach (TNA) for pituitary adenoma is a new alternative for Hardy's surgery (TSS). We performed TNA using only an endoscope through unilateral nostril. In our approach to sphenoid sinus, we apply method of endoscopic sinus surgery (ESS-TNA). We enter the sphenoid sinus directly through the natural ostium and do not brake the nasal septum nor vomer bone. Since September 2004 we had operated on 12 patients by endoscopic TNA. Six were non-functioning adenomas, and 6 were functioning adenomas. We are first to open the ethomoid sinus to make the space for middle concha to be displaced laterally. Secondary, we widen the natural ostium of the sphenoid sinus, retracting the middle concha laterally. The results were compared with those in 10 cases by TSS operated in our institute. Adenoma removal more than 80% was achieved in 58% by endoscopic TNA whereas in 50% by TSS. We had no case with postsurgical infection. Transient DI occurred in 4 cases and 1 case showed permanent. CSF rhinorrhea was seen in the case having small empty sellae in front of adenoma. For this case, we packed the fat tissue at the floor of the sella with endoscope under local anesthesia to close the fistula. Three cases that had hemianopsia before surgery showed the recovery postoperatively. In 6 functional adenoma, postoperative endocrinological examinations showed normalization in 3 cases and improvements in 3 cases. Postsurgical hospitalization days were 11.4 by endoscopic TNA whereas 15.4 by TSS. Our method showed same or better results than TSS in the removal rate and complication rate whereas the postoperative duration of nasal packing and hospitalization days were shorter than TSS.
内镜辅助经鼻入路（TNA）治疗垂体腺瘤是哈代手术（TSS）的一种新选择。我们仅通过单侧鼻孔使用内镜进行TNA。在我们进入蝶窦的方法中，采用了鼻内镜鼻窦手术方法（ESS-TNA）。我们直接通过自然开口进入蝶窦，不破坏鼻中隔和犁骨。自2004年9月以来，我们通过内镜TNA对12例患者进行了手术。其中6例为无功能腺瘤，6例为有功能腺瘤。我们首先打开筛窦，为中鼻甲向外侧移位创造空间。其次，我们扩大蝶窦自然开口，将中鼻甲向外侧牵拉。将结果与我院采用TSS手术的10例患者进行比较。内镜TNA切除腺瘤超过80%的比例为58%，而TSS为50%。我们没有术后感染病例。4例出现短暂性尿崩症，1例为永久性。在腺瘤前方有小空蝶鞍的病例中出现脑脊液鼻漏。对于该病例，我们在内镜下局部麻醉下在鞍底填充脂肪组织以封闭瘘口。3例术前有偏盲的患者术后视力恢复。在6例有功能腺瘤中，术后内分泌检查显示3例恢复正常，3例有所改善。内镜TNA术后住院天数为11.4天，而TSS为15.4天。我们的方法在切除率和并发症发生率方面显示出与TSS相同或更好的结果，而术后鼻腔填塞时间和住院天数比TSS短。
