Lee K J
Laryngoscope. 1978 Jul;88(7 Pt 2 Suppl 10):Suppl 10: 1-65.
A simple and safe technique for the sublabial transseptal transsphenoidal approach to the hypophysis and parasellar region is described. A review of the literature reveals that this technique and other transsphenoidal routes to the hypophysis were performed more than half a century ago.These procedures fell into disfavor because fo low magnification and insufficient illumination of the operative field, infection and inadequate postoperative endocrine replacement therapy. With today's antibiotic therapy and hormonal replacement, plus the use of the operating microscope, the transsphenoidal route to the hypophysis has gained renewed interest among neurosurgeons and otolaryngologists. Each of the transsphenoidal routes and the advantages of the "from below" approach are described. The applications of transsphenoidal approach and the nonsurgical modalities for hypophysectomy are reviewed. The simplicity and safety of the sublabial transseptal transsphenoidal approach depend on a thorough familiarity with the surgical anatomy, proper positioning of the patient, and the availability of appropriate instrumentation. Photographs of specially prepared whole head anatomical specimens plus skull dissections with radiographic correlation illustrate the pertinent anatomy. Some of the vital structures to be identified and avoided are the optic canals, carotid arteries, circular sinuses, cavernous sinuses, III, IV, V, VI cranial nerves, foramen rotundum, medial walls of the orbits, medial walls of maxillary sinuses, medial pterygoid plates and pterygoid canals. A method for preoperative determination of key distances within the patient's skull is described along with other preoperative tests. This paper discusses the self-retaining speculum and other new instruments for this procedure. A gauge mounted on the front end of the speculum is calibrated to measure the size of the opening at the tip of the speculum. Thirty cases are included in this report, six of which are presented in detail. No operative mortality, CSF rhinorrhea, visual damage carotid or cavernous sinus hemorrhage fracture of the medial pterygoid plates or maxilla were encountered in this series. Three patients developed diabetes insipidus and two patients had meningitis which responded to antibiotic therapy.
本文描述了一种用于经唇下鼻中隔经蝶窦入路至垂体及鞍旁区域的简单安全技术。文献回顾显示，这种技术及其他经蝶窦入路至垂体的方法在半个多世纪前就已开展。这些手术因手术视野放大倍数低、照明不足、感染以及术后内分泌替代治疗不充分而不再受青睐。随着当今抗生素治疗和激素替代治疗的应用，加上手术显微镜的使用，经蝶窦入路至垂体在神经外科医生和耳鼻喉科医生中重新引起了兴趣。文中描述了每种经蝶窦入路以及“从下方”入路的优点。对经蝶窦入路的应用及垂体切除术的非手术方式进行了综述。经唇下鼻中隔经蝶窦入路的简单性和安全性取决于对手术解剖结构的透彻熟悉、患者的正确体位以及合适器械的可用性。特别制备的全头部解剖标本照片以及与影像学相关的颅骨解剖图展示了相关解剖结构。一些需要识别并避免损伤的重要结构包括视神经管、颈动脉、环窦、海绵窦、第三、第四、第五、第六颅神经、圆孔、眶内侧壁、上颌窦内侧壁、翼突内侧板和翼管。文中描述了一种术前测定患者颅骨内关键距离的方法以及其他术前检查。本文讨论了用于该手术的自持窥器及其他新器械。安装在窥器前端的量具经过校准，可测量窥器尖端开口的大小。本报告纳入了30例病例，其中6例详细呈现。该系列病例中未发生手术死亡、脑脊液鼻漏、视觉损伤、颈动脉或海绵窦出血、翼突内侧板或上颌骨骨折。3例患者发生尿崩症，2例患者发生脑膜炎，经抗生素治疗后好转。
