Jho H D, Carrau R L, Ko Y, Daly M A
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania, USA.
Surg Neurol. 1997 Mar;47(3):213-22; discussion 222-3. doi: 10.1016/s0090-3019(96)00452-1.
As an element of a minimally invasive management approach, we had developed an endonasal endoscopic transsphenoidal technique for the treatment of pituitary tumors. Initially, four patients were operated on via a sublabial, transseptal approach using a fiberoptic rigid endoscope in conjunction with the operating microscope. Encouraged by that experience, our subsequent 11 patients had undergone endonasal endoscopic transsphenoidal surgery without the use of a retractor or speculum.
Our group of patients included nine females and six males, with an age range of 17-88 years (median: 43 years). There were four microadenomas, four intrasellar macroadenomas, three macroadenomas with suprasellar extension, three invasive macroadenomas involving the cavernous sinus with suprasellar extension, and one metastatic adenocarcinoma.
Thirteen patients with pituitary adenomas experienced resolution of their symptoms postoperatively. One patient with a recurrent prolactinoma responded partially following surgery and subsequently underwent gamma knife radiosurgery. Two patients were treated with postoperative fractionated radiation therapy, one for residual pituitary adenoma in the cavernous sinus, and the other for metastatic adenocarcinoma, respectively. The first patient, treated via an endonasal endoscopic approach for biopsy of the metastatic adenocarcinoma, developed postoperative cerebrospinal fluid (CSF) leak that was successfully managed with endoscopic packing of a fat graft.
The endonasal endoscopic transsphenoidal approach facilitates faster postoperative recovery by the avoidance of traditional incision and postoperative nasal packing. It offers a panoramic view of the sphenoid sinus and excellent visualization of the sellar and suprasellar structures with increased illumination and magnification. Such visualization provides the potential for more complete tumor resection, as well as a better chance of preserving pituitary function and avoiding neurovascular injury.
作为微创治疗方法的一个组成部分，我们研发了一种经鼻内镜经蝶窦技术来治疗垂体肿瘤。最初，4例患者通过唇下经鼻中隔入路，使用纤维光学硬式内镜结合手术显微镜进行手术。受此经验鼓舞，我们随后的11例患者接受了经鼻内镜经蝶窦手术，未使用牵开器或窥器。
我们的患者组包括9名女性和6名男性，年龄范围为17 - 88岁（中位数：43岁）。其中有4例微腺瘤，4例鞍内大腺瘤，3例向鞍上扩展的大腺瘤，3例侵犯海绵窦并向鞍上扩展的侵袭性大腺瘤，以及1例转移性腺癌。
13例垂体腺瘤患者术后症状缓解。1例复发性催乳素瘤患者术后部分缓解，随后接受了伽玛刀放射治疗。2例患者术后接受了分次放射治疗，1例用于海绵窦残留垂体腺瘤，另1例用于转移性腺癌。首例通过经鼻内镜入路进行转移性腺癌活检的患者术后发生脑脊液漏，通过内镜填充脂肪移植物成功处理。
经鼻内镜经蝶窦入路避免了传统切口和术后鼻腔填塞，促进了术后更快恢复。它提供了蝶窦的全景视野，以及对鞍区和鞍上结构的良好可视化，具有增强的照明和放大效果。这种可视化提供了更完整切除肿瘤的可能性，以及更好地保留垂体功能和避免神经血管损伤的机会。
