Zhou Tao, Wei Shao-bo, Meng Xiang-hui, Xu Bai-nan
Department of Neurosurgery, General Hospital of People's Liberation Army, Beijing 100853, China.
Zhonghua Wai Ke Za Zhi. 2010 Oct 1;48(19):1443-6.
To describe the experience with surgical treatment of pituitary adenomas via a fully transnasal endoscopic approach.
Clinical records of 375 cases with pituitary adenomas underwent pure endoscopic operations between December 2006 and December 2009 were carefully assembled. Among 375 pure endoscopic operations of pituitary adenomas, 201 cases were nonfunctional adenomas and 174 cases were functional adenomas. There were 27 giant pituitary adenomas (7.2%) and 41 pituitary adenoma invaded cavernous sinus (10.9%). Intraoperative 1.5 T MRI and neuro-navigation system were used during some operations. The postoperative and follow-up data of patients were analyzed.
There were 234 (79.3%) cases of total resection, 56 (19.0%) cases of subtotal resection, 5 (1.7%) cases of partial resection. Sixty-eight patients had vision improved in 73 patients with vision decreasing before operation. Sixty-eight (77.3%) patients got normal endocrine in 88 hyper-prolactin patient. Fifty-five (84.1%) patients got normal growth hormone in 63 patients with somatotrophinomas. Eighteen (78.2%) patients got normal in 23 patients with corticotrophinoma. These was no death case in this group. One case (0.3%) suffered post-operative coma. Transient decreasing of vision occurred in 2 cases (0.5%). Transient palsy of oculomotor nerve or abducens nerve occurred in 7 cases of operations involved cavernous sinus. Three (0.8%) patients had cerebral meningitis. Two patients (0.5%) suffered from cerebrospinal fluid leak but none underwent operation to repair. Fourteen patients (3.7%) had transient diabetes insipidus. Six patients (1.6%) had nose bleeding.
Trans-nasal endoscopy provides a new device for operation of pituitary adenomas which is effective and safe. Comparing with microscope, endoscopic visual field is clearer, closer and wider.
描述经全鼻内镜入路手术治疗垂体腺瘤的经验。
仔细收集2006年12月至2009年12月间375例行单纯内镜手术的垂体腺瘤患者的临床资料。在375例垂体腺瘤单纯内镜手术中，无功能腺瘤201例，功能性腺瘤174例。有27例巨大垂体腺瘤（7.2%），41例垂体腺瘤侵犯海绵窦（10.9%）。部分手术中使用了术中1.5T磁共振成像和神经导航系统。对患者的术后及随访数据进行分析。
全切除234例（79.3%），次全切除56例（19.0%），部分切除5例（1.7%）。73例术前视力下降的患者中，68例视力改善。88例高泌乳素血症患者中，68例（77.3%）内分泌恢复正常。63例生长激素腺瘤患者中，55例（84.1%）生长激素恢复正常。23例促肾上腺皮质激素腺瘤患者中，18例（78.2%）恢复正常。该组无死亡病例。1例（0.3%）术后昏迷。2例（0.5%）出现短暂视力下降。7例累及海绵窦的手术中出现动眼神经或外展神经短暂麻痹。3例（0.8%）发生脑膜炎。2例（0.5%）出现脑脊液漏，但均未行修补手术。14例（3.7%）出现短暂性尿崩症。6例（1.6%）鼻出血。
经鼻内镜为垂体腺瘤手术提供了一种有效且安全的新手段。与显微镜相比，内镜视野更清晰、更近且更宽。
