Wang Yi Yuen, Thiryayi Wasiq A, Ramaswamy Ragu, Gnanalingham Kanna K
Department of Neurosurgery, Greater Manchester Neuroscience Centre, Salford Royal Foundation Trust Hospital, Greater Manchester, United Kingdom.
Skull Base. 2011 May;21(3):193-200. doi: 10.1055/s-0031-1275635.
We assessed the accuracy of a surgeon's localization of sella margins during endoscopic transsphenoidal surgery for pituitary adenomas, as verified using a neuronavigational system, and we identify types of pathology in which neuronavigation is of most benefit. We performed a prospective cohort study of 32 consecutive patients undergoing image-guided endoscopic transsphenoidal surgery for pituitary adenomas. We assessed the margin of error in the surgeon's localization of the superior and inferior margins of the sella and the lateral margins as determined by the medial border of left and right carotid arteries, using a magnetic resonance-based neuronavigational system. The overall mean error of localization of sella margins by the surgeon was 4.5 ± 3 mm. Localization of the inferior sella margin was more accurate (3.1 ± 2 mm mean error) compared with localization of the left (4.8 ± 3 mm) or right carotid arteries (4.6 ± 3 mm). Giant adenomas (> 2.5 cm), more invasive adenomas (Hardy grade IV), and those with parasellar extension (Hardy grades D and E) were associated with larger errors in localization of the carotid arteries. There was no significant difference when stratifying for recurrent surgery, nostril of approach, and sella morphology. During endoscopic transsphenoidal surgery, the margin of error in the surgeon's estimation of the sella margins for adenomas less than 2.5 cm located predominantly within the sella is relatively small. The margin of error increases for giant adenomas, with greater invasiveness and parasellar spread, and the use of neuronavigation can be especially useful in such cases.
我们评估了在垂体腺瘤的内镜经蝶窦手术中，外科医生对蝶鞍边缘定位的准确性（通过神经导航系统进行验证），并确定了神经导航最具益处的病理类型。我们对32例连续接受影像引导下内镜经蝶窦垂体腺瘤手术的患者进行了前瞻性队列研究。我们使用基于磁共振的神经导航系统，评估了外科医生对蝶鞍上、下边缘以及由左右颈动脉内侧边界确定的外侧边缘定位的误差范围。外科医生对蝶鞍边缘定位的总体平均误差为4.5±3毫米。与左侧（平均误差4.8±3毫米）或右侧颈动脉（平均误差4.6±3毫米）的定位相比，蝶鞍下边缘的定位更准确（平均误差3.1±2毫米）。巨大腺瘤（>2.5厘米）、侵袭性更强的腺瘤（哈代IV级）以及伴有鞍旁扩展的腺瘤（哈代D级和E级）与颈动脉定位的较大误差相关。在对再次手术、手术入路鼻孔和蝶鞍形态进行分层时，没有显著差异。在内镜经蝶窦手术中，对于主要位于蝶鞍内的小于2.5厘米的腺瘤，外科医生对蝶鞍边缘估计的误差范围相对较小。对于巨大腺瘤、侵袭性更强且有鞍旁扩散的情况，误差范围会增加，在这种情况下使用神经导航可能特别有用。
