Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, Canada.
J Neurosurg. 2011 Feb;114(2):345-53. doi: 10.3171/2010.9.JNS10262. Epub 2010 Nov 5.
Whereas most pituitary adenomas are removable via the transsphenoidal approach, certain cases, such as dumbbell-shaped or suprasellar adenomas and recurrent and/or fibrous tumors, remain difficult to treat. The authors present their experience with the extended endoscopic endonasal approach to the suprasellar area in managing this subset of tumors, which are classically treated through a transcranial route.
From June 1997 to December 2008, 615 patients underwent endoscopic endonasal transsphenoidal surgery for pituitary adenomas in the Department of Neurosurgery of the Università degli Studi di Napoli Federico II. Of this group, 20 patients with pituitary adenomas needed an extended endoscopic endonasal transtuberculum/transplanum approach for tumor removal. Two surgical corridors were used during the transsphenoidal approach: 1) the conventional endosellar extraarachnoidal corridor and 2) a suprasellar transarachnoidal corridor.
The extent of resection was gross total in 12 (60%) of the 20 patients, near total in 4 (20%), subtotal in 3 (15%), and partial in 1 (5%). Postoperative CSF leakage occurred in 1 patient. One patient experienced worsening of temporal hemianopsia.
The authors' initial results with the extended endoscopic approach to the suprasellar area for selected pituitary adenomas are promising and may justify a widening of the current classical indications for transsphenoidal surgery.
虽然大多数垂体腺瘤可以通过经蝶窦入路切除，但某些病例，如哑铃形或鞍上腺瘤以及复发性和/或纤维瘤，仍然难以治疗。作者介绍了他们在经蝶窦内镜下扩大经鼻入路治疗这组肿瘤的经验，这些肿瘤经典上通过颅切开术治疗。
1997 年 6 月至 2008 年 12 月，那不勒斯费德里克二世大学神经外科共对 615 例垂体腺瘤患者进行了内镜下经蝶窦经蝶窦手术。在这组患者中，有 20 例垂体腺瘤患者需要通过扩大的内镜下经结节/经筛板入路切除肿瘤。在经蝶窦入路中使用了两个手术通道：1）常规的经鞍内蛛网膜外通道和 2）鞍上蛛网膜内通道。
20 例患者中，12 例（60%）肿瘤切除程度为大体全切除，4 例（20%）为近全切除，3 例（15%）为次全切除，1 例（5%）为部分切除。术后发生 1 例脑脊液漏。1 例患者出现颞侧偏盲加重。
作者对选定的垂体腺瘤采用扩大内镜下经蝶窦入路治疗鞍上区的初步结果令人鼓舞，可能为扩大经蝶窦手术的当前经典适应证提供依据。
