Koktekir Ender, Karabagli Hakan, Ozturk Kayhan
From the Departments of *Neurosurgery and †Otolaryngology, Selcuk University, Konya, Turkey.
J Craniofac Surg. 2015 Jan;26(1):e39-42. doi: 10.1097/SCS.0000000000001298.
The surgical management of giant pituitary adenomas is challenging. Although most pituitary adenomas, even those with suprasellar extension, can be resected using the transsphenoidal surgery alone, the transcranial approach is still needed for approximately 1% to 4% of these tumors. The transcranial approach is usually used in large adenomas with hourglass configuration and adenomas with firm consistency impeding the adjunctive measures, which are used for delivering the suprasellar part of the tumor into the sellar area and thereby obscure the tumor resection by transsphenoidal route. In this report, we describe the successful use of transventricular endoscope as an adjunctive measure to remove giant pituitary adenoma from transsphenoidal route and discuss the limitations of this new technique. We concluded that this technique would be used safely in selected cases. Case selection and surgical strategies should be based on preoperative magnetic resonance imaging findings, ventricular size, and the availability of experienced surgeons.
巨大垂体腺瘤的手术治疗具有挑战性。尽管大多数垂体腺瘤，即使是那些向鞍上扩展的腺瘤，仅通过经蝶窦手术就可以切除，但这些肿瘤中约1%至4%仍需要采用经颅入路。经颅入路通常用于具有沙漏形结构的大型腺瘤以及质地坚硬、妨碍辅助措施的腺瘤，这些辅助措施用于将肿瘤的鞍上部分送入鞍区，从而使经蝶窦途径的肿瘤切除变得困难。在本报告中，我们描述了成功使用经脑室内镜作为辅助措施，从经蝶窦途径切除巨大垂体腺瘤的情况，并讨论了这项新技术的局限性。我们得出结论，这项技术在选定的病例中可以安全使用。病例选择和手术策略应基于术前磁共振成像结果、脑室大小以及经验丰富的外科医生的可用性。
