Feng Shi-Yu, Zhou Tao, Sun Zheng-Hui, Bu Bo, Jiang Jin-Li
Department of Neurosurgery, PLA General Hospital, Beijing, China.
Medicine (Baltimore). 2018 Jun;97(24):e10840. doi: 10.1097/MD.0000000000010840.
The aim of the study was to explore anterior interhemispheric approach microsurgery for removing large sellar region tumors.A total of 118 patients with large sellar region tumors were treated with the anterior interhemispheric approach microsurgery. There were 58 craniopharyngioma, 37 pituitary adenoma, 5 hypothalamic glioma, 7 meningioma, and 11 other tumors cases. The maximal tumor diameter ranged from 3.0 to 8.2 cm, with a mean diameter of 4.3 cm. Diabetes insipidus and fluid and electrolyte imbalance were timely controlled after surgery. Postoperative examination of endocrine and of magnetic resonance imaging (MRI) enhancement scanning of the head were performed.Total, subtotal, and partial removal of tumors was, respectively, achieved in 80, 23, and 15 cases. A total of 109 patients had improved vision after surgery. During the hospital stay, 81 had diabetes insipidus, 68 had fluid and electrolyte imbalance, and 9 had hemorrhage and tumidness in the right frontal lobe (3 had frontal lobe contusion, and 6 had frontal lobe hematoma). The postoperative follow-up visit lasted for 3 to 105 months. During the follow-up period, 14 patients had recurrence of tumors, 38 cases had their single or multiple pituitary axis treated with hormonal replacement therapy for a long time after surgery, and 23 cases had to orally take drugs for the purpose of controlling diabetes insipidus.The anterior interhemispheric approach microsurgery is feasible for removing large sellar region tumors without significant sequels. Active postoperative managements of diabetes insipidus and fluid and electrolyte imbalance may help patients with earlier recovery.
本研究的目的是探讨经纵裂前部入路显微手术切除大型鞍区肿瘤。共有118例大型鞍区肿瘤患者接受了经纵裂前部入路显微手术治疗。其中颅咽管瘤58例，垂体腺瘤37例，下丘脑胶质瘤5例，脑膜瘤7例，其他肿瘤11例。肿瘤最大直径为3.0～8.2cm，平均直径为4.3cm。术后及时控制了尿崩症及水电解质紊乱。术后进行了内分泌检查及头部磁共振成像（MRI）增强扫描。肿瘤全切除、次全切除和部分切除分别为80例、23例和15例。共有109例患者术后视力改善。住院期间，81例出现尿崩症，68例出现水电解质紊乱，9例出现右额叶出血及肿胀（3例为额叶挫伤，6例为额叶血肿）。术后随访3～105个月。随访期间，14例患者肿瘤复发，38例患者术后长期接受单种或多种垂体轴激素替代治疗，23例患者需口服药物控制尿崩症。经纵裂前部入路显微手术切除大型鞍区肿瘤是可行的，且无明显后遗症。积极进行术后尿崩症及水电解质紊乱的管理可能有助于患者早日康复。
