Department of Neurosurgery, Brain Tumor Center at the University of Cincinnati Neuroscience Institute and University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0515, USA.
J Neurosurg. 2010 Apr;112(4):736-43. doi: 10.3171/2009.6.JNS08916.
Endoscopic approaches to pituitary tumors have become an effective alternative to traditional microscopic transsphenoidal approaches. Despite a proven potential to decrease unexpected residual tumor, intraoperative MR (iMR) imaging is infrequently used even in the few operating environments in which such technology is available. Its use is prohibitive because of its cost, increased complexity, and longer operative times. The authors assessed the potential of intrasellar endoscopy to replace the need for iMR imaging without sacrificing the maximum extent of resection.
In this retrospective study, 27 consecutive patients underwent fully endoscopic resection of pituitary macroadenomas. Intrasellar endoscopy was used to determine the presence of residual tumor within the sella turcica and tumor cavity. Intraoperative MR imaging was used to identify rates of unexpected residual tumor and the need for further tumor resection.
Intraoperative estimates of the extent of tumor resection were correct in 23 patients (85%). Of 4 patients with unacceptable tumor residuals, 3 underwent further tumor resection. After iMR imaging, the rate of successful completion of the planned extent of resection increased to 26 patients (96%). Rates of both endocrinopathy reversal and postoperative complications were consistent with previously published results for microscopic and endoscopic resection techniques.
The findings in this study provided quantitative evidence that intrasellar endoscopy has significant promise for maximizing the extent of tumor resection and is a useful adjunct to surgical approaches to pituitary tumors, particularly when iMR imaging is unavailable. A larger prospective study on the extent of resection following endoscopic transsphenoidal surgery would strengthen these findings.
经蝶窦入路的内镜手术已成为一种替代传统显微镜经蝶窦入路的有效方法。尽管已证实其具有降低意外残留肿瘤的潜力，但即使在少数可应用该技术的手术环境中，术中磁共振成像（iMR）也很少使用。由于其成本高、复杂性增加和手术时间延长，其应用受到限制。作者评估了经蝶窦内镜术替代 iMR 成像的潜力，而不牺牲最大限度的肿瘤切除范围。
在这项回顾性研究中，27 例连续的垂体大腺瘤患者接受了完全内镜切除术。在蝶鞍内使用内镜检查以确定蝶鞍内和肿瘤腔内是否存在残留肿瘤。术中磁共振成像用于识别意外残留肿瘤的发生率和进一步肿瘤切除的需要。
23 例患者（85%）的肿瘤切除范围的术中估计是正确的。4 例肿瘤残留不可接受的患者中，有 3 例接受了进一步的肿瘤切除。在 iMR 成像后，计划切除范围的成功完成率增加到 26 例（96%）。内分泌逆转和术后并发症的发生率与显微镜和内镜切除技术的先前发表结果一致。
本研究的结果提供了定量证据，表明蝶鞍内内镜检查在最大限度地提高肿瘤切除范围方面具有很大的潜力，是治疗垂体肿瘤手术方法的有用辅助手段，特别是在无法进行 iMR 成像时。一项关于内镜经蝶窦手术后切除范围的更大前瞻性研究将加强这些发现。
