Takahashi Y, Minemura K, Endo S, Kodama N, Suzuki J
No Shinkei Geka. 1980 Jul;8(7):655-8.
A case of giant pituitary adenoma was reported. The patient was a 47-year-old man with visual disturbance. CT scan revealed the huge tumor, about 6 cm in diameter, at the midportion over the sella turcica, extending to the frontal, temporal, posterior and hypothalamic region. Total resection of the tumor was successfully carried out and the difficult post-operative complications were overcome. In this paper we mainly discussed the operative procedure for giant pituitary region tumor, which usually involve the main cerebral arteries, i.e., A1 and A2 portion of the anterior cerebral artery (ACA), anterior communicating artery (ACOMA) and intracranial internal carotid artery (ICA). We used to expose the internal carotid artery at the neck for the temporary occlusion prior to craniotomy. Prolongation of the temporary occlusion time is achieved by intravenous administration of 800 ml-20% mannitol solution. After bifrontal craniotomy, we approach the tumor interhemispherically and expose the A2 portion of ACA. Then anterior communicating artery, A1 portion of ACA and ICA are exposed as the tumor is extirpated. Under the bifrontal craniotomy, as we separate bilateral Sylvian fissure and interhemisphere, we can get the wide operative field and we can also approach the tumor from various direction. Therefore, even the tumor is huge, it is possible to remove the tumor without brain damage, vessel and cranial nerve injury.
报告了一例巨大垂体腺瘤病例。患者为一名47岁男性，有视觉障碍。CT扫描显示在蝶鞍中部有一个直径约6厘米的巨大肿瘤，延伸至额叶、颞叶、后部及下丘脑区域。成功进行了肿瘤全切，并克服了术后的棘手并发症。本文主要讨论了巨大垂体区肿瘤的手术操作，该手术通常涉及大脑主要动脉，即大脑前动脉（ACA）的A1和A2段、前交通动脉（ACOMA）及颅内颈内动脉（ICA）。我们过去常在开颅手术前在颈部暴露颈内动脉以进行临时阻断。通过静脉注射800毫升20%的甘露醇溶液来延长临时阻断时间。采用双额开颅术后，经半球间入路接近肿瘤并暴露ACA的A2段。然后在切除肿瘤时暴露前交通动脉、ACA的A1段及ICA。在双额开颅情况下，当我们分离双侧外侧裂和半球间区域时，可以获得广阔的手术视野，并且还能从各个方向接近肿瘤。因此，即使肿瘤巨大，也有可能在不损伤脑、血管及脑神经的情况下切除肿瘤。
