Department of Neurosurgery, Boston Medical Center, Boston, Massachusetts, USA.
World Neurosurg. 2011 Jul-Aug;76(1-2):149-55. doi: 10.1016/j.wneu.2010.10.038.
This study sought to report on the utility and safety of the flexible-fiber CO2 laser in endoscopic endonasal transsphenoidal surgery.
A retrospective chart review identified 16 patients who underwent laser-assisted transsphenoidal surgery. All tumor pathology types were considered. Results were assessed based on hormone status, tumor size, pathology, complications, and resection rates.
Sixteen pituitary lesions (pituitary adenomas, 12; Rathke cleft cyst, 2; pituitary cyst and craniopharyngioma, 1 each) with an average size of 22.7 mm were identified by radiographic and pathologic criteria. All patients underwent flexible-fiber CO2 laser-assisted endoscopic endonasal transsphenoidal surgery. Of the adenomas, 8 were nonsecreting and 4 were secreting (3 prolactinomas and 1 ACTH secreting). Gross total resection was achieved in 7 of 16 patients (43.75%) with hormone remission in all patients (100%) after a mean follow-up of 19.3 months. Postoperative complications occurred in 3 patients (18.75%): 2 patients developed transient diabetes insipidus (DI) and 1 developed a CSF leak requiring surgical repair. Five patients (31.25%) underwent postoperative radiation to the residual lesions.
We found that CO2-laser-assisted endoscopic endonasal transsphenoidal surgery for sellar tumors is a minimally invasive approach using a tool that is quick and effective at cutting and coagulation. The surgery has a low rate of complication, and no laser-related complications were encountered. The laser fiber allows the surgeon to safely cut and coagulate without the line-of-sight problems encountered with conventional CO2 lasers. Further studies are recommended to further define its role in endoscopic endonasal sellar surgery.
本研究旨在报告纤维软激光在经鼻内镜颅底手术中的应用价值和安全性。
回顾性图表分析确定了 16 例行激光辅助经蝶窦手术的患者。所有肿瘤病理类型均被考虑在内。根据激素状态、肿瘤大小、病理、并发症和切除率评估结果。
根据影像学和病理学标准，确定了 16 例垂体病变（垂体腺瘤 12 例；Rathke 裂囊肿 2 例；垂体囊肿和颅咽管瘤各 1 例），平均大小为 22.7mm。所有患者均接受了纤维软激光辅助经鼻内镜经蝶窦手术。在这些腺瘤中，8 例为无分泌功能腺瘤，4 例为分泌功能腺瘤（3 例泌乳素瘤和 1 例 ACTH 分泌瘤）。16 例患者中有 7 例（43.75%）达到大体全切除，所有患者（100%）在平均随访 19.3 个月后激素缓解。术后并发症发生在 3 例患者（18.75%）：2 例患者出现短暂性尿崩症（DI），1 例患者出现需要手术修复的脑脊液漏。5 例患者（31.25%）接受了残余病变的术后放疗。
我们发现，CO2 激光辅助经鼻内镜经蝶窦手术治疗鞍区肿瘤是一种微创方法，使用的工具切割和凝血效果迅速有效。该手术并发症发生率低，未发生与激光相关的并发症。激光纤维允许外科医生安全地切割和凝血，而不会遇到传统 CO2 激光遇到的视线问题。建议进一步研究以进一步确定其在经鼻内镜鞍区手术中的作用。
