Department of Neurosurgery, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
Department of Radiology, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
World Neurosurg. 2014 Jul-Aug;82(1-2):186-95. doi: 10.1016/j.wneu.2013.02.032. Epub 2013 Feb 9.
To present a large series of patients and examine the learning curve of the endonasal endoscopic transplanum, transtuberculum approach for primarily suprasellar or sellar-suprasellar tumors.
We identified 122 patients who underwent 126 surgeries using the transplanum, transtuberculum approach. Extent of resection was determined with volumetric analysis of magnetic resonance imagings. Results concerning vision, endocrine function, and complications were noted.
Average tumor volume was 14 cm(3). The most frequent pathologies were pituitary macroadenoma (51.6%), craniopharyngioma (20.6%), and meningioma (15.9%). A total of 73% patients presented with visual compromise. Rates of gross total resection (GTR) and near total resection for the group as a whole were 58.1% and 13.7%, and for the patients in whom GTR was intended (n = 90), rates of GTR and near total resection were 77.5% and 12.5% for a total of 90%. Extent of resection in this group was 97.6%. Vision improved in 52.4% and deteriorated in 4.8%. Favorable endocrine outcome occurred in 63.5%. The cerebrospinal fluid leak rate was 3.1% for the series as a whole. It improved from 6.3% in the first half of the series to 0 in the second half. Leak rates varied with technique from 11% (fat graft only) to 4.2% (gasket seal only) to 1.8% (fat plus nasoseptal flap) to 0 (gasket plus nasoseptal flap). The rate of other complications was 14.3% in the first half of the series and 1.6% in the second half. There was one infection (0.8%).
The endonasal endoscopic transtuberculum transplanum approach is a safe and effective minimal access approach to midline pathology in the suprasellar cistern.
介绍一系列患者，并研究经蝶骨-鞍结节内镜颅底入路治疗原发性鞍上或鞍上-鞍内肿瘤的学习曲线。
我们确定了 122 名接受经蝶骨-鞍结节内镜颅底入路手术的患者，共 126 例。通过磁共振成像的体积分析确定切除范围。记录与视力、内分泌功能和并发症相关的结果。
平均肿瘤体积为 14cm³。最常见的病变是垂体大腺瘤（51.6%）、颅咽管瘤（20.6%）和脑膜瘤（15.9%）。共有 73%的患者出现视力障碍。全切除（GTR）和近全切除率为 58.1%和 13.7%，对于打算行 GTR 的 90 名患者，GTR 和近全切除率分别为 77.5%和 12.5%，共计 90 例。本组患者的切除程度为 97.6%。52.4%的患者视力改善，4.8%的患者视力恶化。63.5%的患者内分泌功能良好。总体脑脊液漏发生率为 3.1%。在前半段，发生率为 6.3%，在后半段，发生率为 0。漏液率随技术而变化，从脂肪移植组的 11%到密封垫圈组的 4.2%，再到脂肪和鼻中隔瓣组的 1.8%，最后到密封垫圈和鼻中隔瓣组的 0%。前半段并发症发生率为 14.3%，后半段为 1.6%。感染 1 例（0.8%）。
经蝶骨-鞍结节内镜颅底入路是一种安全有效的微创手术方法，适用于鞍上池的中线病变。
