Locatelli Marco, Di Cristofori Andrea, Draghi Riccardo, Bertani Giulio, Guastella Claudio, Pignataro Lorenzo, Mantovani Giovanna, Rampini Paolo, Carrabba Giorgio
Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Unit of Neurosurgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy.
World Neurosurg. 2017 Apr;100:173-179. doi: 10.1016/j.wneu.2016.12.123. Epub 2017 Jan 5.
The transsphenoidal approach is considered the gold standard for resection of pituitary adenomas and other sellar region lesions. This approach is guided by a few fundamental anatomic landmarks that conduct the surgeon toward the sellar floor. Some anatomic structures may vary a lot (e.g., intrasphenoidal septa, intercarotid distance) and may be difficult to identify. Pneumatization and conformation of the sphenoidal sinus (SS) plays a key role in accessing the floor of the sella and other skull base structures. A poorly pneumatized SS may be a relative contraindication to the transsphenoidal approach. We analyzed outcome and complications in transsphenoidal surgery for sellar lesions with a difficult SS.
We analyzed 243 consecutive patients who underwent a transsphenoidal approach for sellar lesions. Patients with poor pneumatization of the SS were included. Neurosurgical and endocrinologic outcomes were reported.
Successful treatment using a transsphenoidal approach with neuronavigation and Doppler ultrasound was achieved in 15 patients with a low degree of pneumatization of the SS. A pituitary adenoma was present in 13 of 15 patients. Endocrinologic and neurosurgical outcomes were similar to patients with normal pneumatization of the SS, showing a cure of disease in 6 of 9 patients with functioning adenomas and an improvement of symptoms in cases of nonfunctioning adenomas.
Patients with a poorly pneumatized SS can be treated safely with a transsphenoidal approach using image guidance techniques to avoid major neurovascular complications.
经蝶窦入路被认为是切除垂体腺瘤和其他鞍区病变的金标准。该入路由一些引导外科医生到达鞍底的基本解剖标志引导。一些解剖结构可能差异很大（例如蝶窦内隔、颈内动脉间距），可能难以识别。蝶窦（SS）的气化和形态在进入鞍底及其他颅底结构中起关键作用。气化不良的蝶窦可能是经蝶窦入路的相对禁忌证。我们分析了经蝶窦手术治疗具有复杂蝶窦的鞍区病变的结果及并发症。
我们分析了243例连续接受经蝶窦入路治疗鞍区病变的患者。纳入蝶窦气化不良的患者。报告神经外科和内分泌学结果。
15例蝶窦气化程度低的患者通过经蝶窦入路联合神经导航和多普勒超声成功治疗。15例患者中有13例存在垂体腺瘤。内分泌学和神经外科结果与蝶窦气化正常的患者相似，9例功能性腺瘤患者中有6例疾病治愈，无功能性腺瘤患者症状改善。
蝶窦气化不良的患者可通过经蝶窦入路并采用影像引导技术进行安全治疗，以避免严重的神经血管并发症。
