Cote David J, Wiemann Robert, Smith Timothy R, Dunn Ian F, Al-Mefty Ossama, Laws Edward R
Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
World Neurosurg. 2015 Oct;84(4):899-905. doi: 10.1016/j.wneu.2015.05.019. Epub 2015 May 22.
The transsphenoidal approach was initially developed in neurosurgical practice as an operative approach to the pituitary gland. The introduction of the operating endoscope has improved the versatility of the transsphenoidal approach, broadening the spectrum of lesions that can be treated effectively with this operative strategy.
We performed a retrospective review of all patients who underwent transnasal, transsphenoidal operations at Brigham and Women's Hospital from April 2008 to February 2015 and categorized each case by pathologic diagnosis.
A total of 792 transnasal, transsphenoidal operations (512 endoscopic) were performed by 9 neurosurgeons for 33 pathologies over a 7-year period. Pituitary adenomas (535, 67.55%) were the most common impetus for a transsphenoidal operation. Others included Rathke cleft cysts (86, 10.86%), craniopharyngiomas (25, 3.16%), lympocytic hypophysitis/pituitary inflammation (21, 2.65%), arachnoid cysts (8, 1.01%), spindle cell oncocytoma (4, 0.51%), colloid cysts (4, 0.51%), and pituicytoma (2, 0.25%). Pituitary hyperplasia was treated in 9 cases (1.14%) and pituitary apoplexy in 7 (0.88%). Nineteen operations were undertaken for postoperative repairs (2.40%) and 3 for abscesses (0.38%). Other diseases treated transsphenoidally included chordomas (12, 1.52%), metastases (9, 1.14%), meningiomas (5, 0.63%), clival lesions (4, 0.51%), germinomas (3, 0.38%), granulomas (2, 0.25%), dermoid tumors (2, 0.25%), and 1 (0.13%) each of esthesioneuroblastoma, granular cell tumor, Wegener granulomatosis, olfactory neuroblastoma, glioneuronal tumor, chondromyxoid fibroma, epidermoid, meningoencephalocele, aneurysm, neuroendocrine carcinoma, chondrosarcoma, and lymphoma.
Although initially devised in neurosurgical practice for tumors of the pituitary gland, developments in technology now make the transsphenoidal approach an effective operative strategy for a wide range of anterior skull base lesions.
经蝶窦入路最初是在神经外科手术中作为一种治疗垂体的手术入路而发展起来的。手术内窥镜的引入提高了经蝶窦入路的多功能性，拓宽了可以通过这种手术策略有效治疗的病变范围。
我们对2008年4月至2015年2月在布莱根妇女医院接受经鼻、经蝶窦手术的所有患者进行了回顾性研究，并根据病理诊断对每个病例进行了分类。
9名神经外科医生在7年时间里共进行了792例经鼻、经蝶窦手术（512例为内窥镜手术），涉及33种病理类型。垂体腺瘤（535例，67.55%）是经蝶窦手术最常见的病因。其他包括拉克氏囊肿（86例，10.86%）、颅咽管瘤（25例，3.16%）、淋巴细胞性垂体炎/垂体炎症（21例，2.65%）、蛛网膜囊肿（8例，1.01%）、梭形细胞嗜酸细胞瘤（4例，0.51%）、胶样囊肿（4例，0.51%）和垂体细胞瘤（2例，0.25%）。9例（1.14%）患者接受了垂体增生的治疗，7例（0.88%）患者接受了垂体卒中的治疗。19例（2.40%）手术用于术后修复，3例（0.38%）手术用于治疗脓肿。经蝶窦治疗的其他疾病包括脊索瘤（12例，1.52%）、转移瘤（9例，1.14%）、脑膜瘤（5例，0.63%）、斜坡病变（4例，0.51%）、生殖细胞瘤（3例，0.38%）、肉芽肿（2例，0.25%）、皮样肿瘤（2例，0.25%），以及嗅神经母细胞瘤、颗粒细胞瘤、韦格纳肉芽肿、嗅神经母细胞瘤、神经胶质神经元肿瘤、软骨黏液样纤维瘤、表皮样囊肿、脑膜脑膨出、动脉瘤、神经内分泌癌、软骨肉瘤和淋巴瘤各1例（0.13%）。
尽管经蝶窦入路最初是在神经外科手术中为垂体肿瘤设计的，但技术的发展现在使经蝶窦入路成为治疗多种前颅底病变的有效手术策略。
