Research Institute for Pituitary Disease, Southern Tohoku General Hospital Koriyama, Japan.
Front Endocrinol (Lausanne). 2012 Feb 20;3:25. doi: 10.3389/fendo.2012.00025. eCollection 2012.
Craniopharyngiomas are difficult to treat. The extended transsphenoidal approach has recently been described in several small series. We describe the usefulness of microscopy-assisted angled endoscopy for visualizing vital structures such as tumor attachment or tumor invasion to the pituitary stalk to achieve confident radical tumor removal. Between 2006 and 2010, 15 patients underwent the microscopy-assisted extended transsphenoidal approach for resection of entirely suprasellar craniopharyngiomas. Fourteen patients had the transinfundibular type, and one had the transinfundibular type with extension to the third ventricle. We observed color change within the pituitary stalk by endoscopy. The pituitary stalk was cut intentionally in 10 patients because of suspected tumor invasion surrounding the stalk. Total removal was accomplished in nine patients. Pathological specimens from the pituitary stalk showed tumor invasion spreading over the surface of the pituitary stalk, shown by a discolored pituitary stalk, and this was essential for confident radical tumor removal. Even after stalk resection, postoperative diabetes insipidus was minimal when a bright signal on T1 in the posterior lobe was not observed with preoperative magnetic resonance imaging. Confident radical tumor removal is possible with the introduction of the endoscopy-assisted microscopic extended transsphenoidal approach.
颅咽管瘤难以治疗。最近在几个小系列中描述了经扩展的经蝶窦入路。我们描述了显微镜辅助的角度内窥镜在观察重要结构（如肿瘤附着或肿瘤侵袭垂体柄）以实现自信的肿瘤根治性切除方面的有用性。2006 年至 2010 年间，15 名患者接受了显微镜辅助的扩展经蝶窦入路切除完全鞍上颅咽管瘤。14 名患者为经蝶骨漏斗型，1 名患者为经蝶骨漏斗型延伸至第三脑室。我们通过内窥镜观察到垂体柄内的颜色变化。由于怀疑肿瘤侵袭围绕垂体柄，10 名患者有意切除垂体柄。9 名患者实现了完全切除。垂体柄的病理标本显示肿瘤侵袭扩散到垂体柄表面，垂体柄颜色变深，这对于自信的肿瘤根治性切除至关重要。即使在切除垂体柄后，如果术前磁共振成像未观察到后叶 T1 上的明亮信号，术后也很少发生尿崩症。引入内窥镜辅助显微镜下扩展经蝶窦入路可实现自信的肿瘤根治性切除。
