El-Fiki Mohamed E, Aly Ahmed, Elwany Samy
Department of Neurosurgery, Alexandria Medical School, Alexandria, Egypt.
J Neurol Surg B Skull Base. 2012 Aug;73(4):287-91. doi: 10.1055/s-0032-1312714.
A prospective study was performed on 80 cases of different types of sellar lesions during the period between January 2007 and December 2010. The binasal approach was used in all patients. Functioning lesions were diagnosed in 59 patients. The most common secretory tumors were prolactinomas (37 patients) followed by adrenocorticotropic hormone producing tumors (11 patients) and growth hormone producing tumors (11 patients). Nonfunctioning lesions included: 14 pituitary adenomas, 2 chordomas, 2 metastatic lesions (ovarian carcinoma and thyroid carcinoma), and 1 case of sarcoidosis, Rathke's cleft cyst, and craniopharyngioma. Seven nonfunctioning cases developed apoplexy. Among the 59 patients with functioning pituitary lesions, postoperative endocrinological control was achieved in 51 of them (86.5%) 3 months postoperatively with normalization of pituitary functions and complete tumor resection as proved by postoperative magnetic resonance imaging. Postoperative visual field defect improvement was achieved in 15 out of 23 patients (65.2%), including the cases with apoplexy, with complete tumor resection. Postoperative discomfort such as headache, vomiting, or dizziness was minimal and hospitalization period was 2 to 3 days. Postoperative leak continued in one patient in whom revision surgical repair was performed 7 days later. The merits, outcome, and limitations of the approach were discussed.
2007年1月至2010年12月期间，对80例不同类型的鞍区病变患者进行了一项前瞻性研究。所有患者均采用双侧鼻腔入路。59例患者被诊断为功能性病变。最常见的分泌性肿瘤是催乳素瘤（37例），其次是促肾上腺皮质激素分泌瘤（11例）和生长激素分泌瘤（11例）。无功能性病变包括：14例垂体腺瘤、2例脊索瘤、2例转移瘤（卵巢癌和甲状腺癌），以及1例结节病、拉克氏囊肿和颅咽管瘤。7例无功能性病变发生了卒中。在59例有功能性垂体病变的患者中，51例（86.5%）在术后3个月实现了内分泌学控制，垂体功能恢复正常，术后磁共振成像证实肿瘤完全切除。23例患者中有15例（65.2%）术后视野缺损得到改善，包括发生卒中的病例，肿瘤均完全切除。术后头痛、呕吐或头晕等不适症状轻微，住院时间为2至3天。1例患者术后持续发生脑脊液漏，7天后进行了翻修手术修复。讨论了该入路的优点、结果和局限性。
