Neurosurgical Center of Pituitary Tumors, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
J Neurosurg. 2010 Jan;112(1):108-17. doi: 10.3171/2009.3.JNS0929.
The standard transsphenoidal approach has been successfully used to resect most pituitary adenomas. However, as a result of the limited exposure provided by this procedure, complete surgical removal of pituitary adenomas with parasellar or retrosellar extension remains problematic. By additional bone removal of the cranial base, the extended transsphenoidal approach provides better exposure to the parasellar and clival region compared with the standard approach. The authors describe their surgical experience with the extended transsphenoidal approach to remove pituitary adenomas invading the anterior cranial base, cavernous sinus (CS), and clivus.
Retrospective analysis was performed in 126 patients with pituitary adenomas that were surgically treated via the extended transsphenoidal approach between September 1999 and March 2008. There were 55 male and 71 female patients with a mean age of 43.4 years (range 12-75 years). There were 82 cases of macroadenoma and 44 cases of giant adenoma.
Gross-total resection was achieved in 78 patients (61.9%), subtotal resection in 43 (34.1%), and partial resection in 5 (4%). Postoperative complications included transient cerebrospinal rhinorrhea (7 cases), incomplete cranial nerve palsy (5), panhypopituitarism (5), internal carotid artery injury (2), monocular blindness (2), permanent diabetes insipidus (1), and perforation of the nasal septum (2). No intraoperative or postoperative death was observed.
The extended transsphenoidal approach provides excellent exposure to pituitary adenomas invading the anterior cranial base, CS, and clivus. This approach enhances the degree of tumor resection and keeps postoperative complications relatively low. However, radical resection of tumors that are firm, highly invasive to the CS, or invading multidirectionally remains a big challenge. This procedure not only allows better visualization of the tumor and the neurovascular structures but also provides significant working space under the microscope, which facilitates intraoperative manipulation. Preoperative imaging studies and new techniques such as the neuronavigation system and the endoscope improve the efficacy and safety of tumor resection.
标准经蝶窦入路已成功用于切除大多数垂体腺瘤。然而，由于该手术方法提供的暴露有限，对于具有鞍旁或鞍后延伸的垂体腺瘤，完全手术切除仍然存在问题。通过颅底额外的骨质切除，扩展经蝶窦入路与标准入路相比，可提供更好的鞍旁和斜坡区域暴露。作者描述了他们使用扩展经蝶窦入路切除侵袭颅前窝、海绵窦（CS）和斜坡的垂体腺瘤的手术经验。
对 1999 年 9 月至 2008 年 3 月期间通过扩展经蝶窦入路手术治疗的 126 例垂体腺瘤患者进行回顾性分析。患者中男 55 例，女 71 例，平均年龄 43.4 岁（12-75 岁）。其中 82 例为大腺瘤，44 例为巨大腺瘤。
78 例（61.9%）患者实现了大体全切除，43 例（34.1%）患者实现了次全切除，5 例（4%）患者实现了部分切除。术后并发症包括短暂性脑脊液鼻漏（7 例）、不完全颅神经麻痹（5 例）、垂体功能减退（5 例）、颈内动脉损伤（2 例）、单眼失明（2 例）、永久性尿崩症（1 例）和鼻中隔穿孔（2 例）。无术中或术后死亡。
扩展经蝶窦入路为侵袭颅前窝、CS 和斜坡的垂体腺瘤提供了极好的显露。这种方法提高了肿瘤切除程度，使术后并发症相对较低。然而，对于质地坚硬、高度侵袭性 CS 或多方向侵袭的肿瘤的根治性切除仍然是一个巨大的挑战。该手术不仅可以更好地观察肿瘤和神经血管结构，还可以在显微镜下提供更大的工作空间，便于术中操作。术前影像学研究和新的技术，如神经导航系统和内镜，提高了肿瘤切除的疗效和安全性。
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