Wongsirisuwan Methee
Division of Neurosurgery, Department of Surgery, Rajavithi Hospital, College ofMedicine, Rangsit University, Bangkok, Thailand.
J Med Assoc Thai. 2011 Jul;94(7):888-95.
Endoscopic endonasal transsphenoidal approach (EETA) is an acceptable procedure as truly minimally invasive neurosurgery in handling pituitary tumor. EETA can serve many patients in many aspects especially the hospital stay and the scarification. However EETA still has some limitations that can cause serious complications. These complications such as cerebrospinal fluid leakage and bleeding control are less likely to occur ifneurosurgeons use conventional approach named as Pterional approach which was described by Yarsargil. To gain the benefit of both pterional approach and minimally invasive surgery Keyhole Supraorbital Approach (KSA) was proposed by Perneczky in 1999. This approach has not the mentioned limitation. However, there are many controversies between these two approaches in that what is the better minimally invasive surgery in pituitary surgery? The present article, by clearing the pro and con of each approach, can help neurosurgeons select the most appropriate way in handling pituitary surgery.
鼻内镜下经蝶窦入路（EETA）作为真正的微创神经外科手术来处理垂体瘤是一种可接受的手术方法。EETA在许多方面可以为许多患者提供便利，尤其是住院时间和瘢痕形成方面。然而，EETA仍然存在一些可能导致严重并发症的局限性。如果神经外科医生采用由亚萨吉尔描述的传统翼点入路，这些并发症如脑脊液漏和出血控制等不太可能发生。为了同时获得翼点入路和微创手术的益处，佩尔内茨基于1999年提出了眶上锁孔入路（KSA）。这种入路没有上述局限性。然而，在垂体手术中哪种微创手术更好这一问题上，这两种入路之间存在许多争议。本文通过阐明每种入路的优缺点，可以帮助神经外科医生选择处理垂体手术的最合适方法。
