Wang Shousen, Xiao Deyong, Wang Rumi, Wei Liangfeng, Hong Jingfang
From the Department of Neurosurgery, Fuzhou General Hospital, Fujian Medical University, Fuzhou, People's Republic of China.
J Craniofac Surg. 2015 Mar;26(2):452-5. doi: 10.1097/SCS.0000000000001226.
To investigate the surgical strategy of repeated microscopic transsphenoidal surgery (TSS) for treatment of pituitary adenoma, surgical techniques and treatment outcomes for 29 patients with pituitary adenoma were reviewed and analyzed. There were 17 patients who underwent TSS 18 times and 12 patients who underwent TSS 13 times. The interval between each TSS ranged from 3 months to 18 years, with a median time of 4 years. The tumor height was 15 to 45 mm on the last surgery. Among the 29 patients, 16 patients underwent total tumor resection, 11 patients underwent subtotal resection, and 2 patients underwent partial resection. Cerebrospinal fluid leak occurred in 10 patients. Among 24 patients who were followed up effectively, 1 patient developed abducens paralysis after surgery, 1 patient had chronic diabetes insipidus, and 1 patient received steroid-dependent alternative treatment. The repeated TSS may present satisfied outcomes in experienced hands. The upper edge of the posterior choanae should be identified to ensure the right orientation. The openings of the anterior wall of the sphenoid sinus and the sellar floor should be appropriately expanded to improve tumor exposure. The artificial materials should be identified and removed carefully. Intraoperative cerebrospinal fluid leakage should be managed well.
为探讨垂体腺瘤重复经蝶窦显微手术（TSS）的手术策略，回顾分析29例垂体腺瘤患者的手术技术及治疗效果。17例患者接受了18次TSS，12例患者接受了13次TSS。每次TSS间隔时间为3个月至18年，中位时间为4年。末次手术时肿瘤高度为15至45mm。29例患者中，16例患者肿瘤全切除，11例患者次全切除，2例患者部分切除。10例患者发生脑脊液漏。在24例得到有效随访的患者中，1例患者术后发生外展神经麻痹，1例患者患有慢性尿崩症，1例患者接受了依赖类固醇的替代治疗。在经验丰富的医生手中，重复TSS可能会取得满意的效果。应识别后鼻孔上缘以确保正确的方向。蝶窦前壁和鞍底开口应适当扩大以改善肿瘤暴露。应仔细识别并清除人工材料。术中脑脊液漏应妥善处理。
