Prevedello Daniel M, Thomas Ajith, Gardner Paul, Snyderman Carl H, Carrau Ricardo L, Kassam Amin B
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Neurosurgery. 2007 Apr;60(4 Suppl 2):E401; discussion E401. doi: 10.1227/01.NEU.0000255359.94571.91.
The presence of a sellar macroadenoma with a concomitant tuberculum sellae meningioma typically requires a craniotomy for extirpation of the meningioma. We describe a single endoscopic approach for resection of both lesions.
A 52-year-old woman with complaints of continuous headache and right temporal visual field loss was found to have a 1.9 x 2.1 x 1.7-cm enhancing sellar mass on magnetic resonance imaging scans associated with a second enhancing extra-axial lesion at the planum sphenoidale measuring 1.0 x 0.6 cm and encroaching on the right optic nerve.
After the endoscopic transnasal resection of the pituitary tumor, the planum sphenoidale was drilled and the underlying dura was incised. The suprasellar tumor was identified and completely resected. Histological evaluation confirmed the concomitant presence of a meningioma and pituitary adenoma.
With advances in endoscopic and image-guidance technology and increasing understanding of the endoscopic anatomy of the sellar region, surgeons are capable of reaching both intrasellar and suprasellar/anterior cranial base region tumors through a single endoscopic approach. The use of endoscopes in transsphenoidal approaches may obviate the need for additional craniotomies in properly selected patients.
蝶鞍区巨大腺瘤合并鞍结节脑膜瘤通常需要开颅手术切除脑膜瘤。我们描述一种单一的内镜入路切除这两种病变。
一名52岁女性，主诉持续头痛和右侧颞侧视野缺损，磁共振成像扫描发现蝶鞍区有一个1.9×2.1×1.7 cm的强化肿块，同时在蝶骨平台有一个1.0×0.6 cm的强化轴外病变，侵犯右侧视神经。
经鼻内镜切除垂体瘤后，磨除蝶骨平台并切开其下方硬脑膜。识别并完全切除鞍上肿瘤。组织学评估证实同时存在脑膜瘤和垂体腺瘤。
随着内镜和图像引导技术的进步以及对蝶鞍区内镜解剖结构的认识不断加深，外科医生能够通过单一的内镜入路到达鞍内及鞍上/前颅底区域的肿瘤。在适当选择的患者中，经蝶窦入路使用内镜可能无需额外的开颅手术。
