Aust M R, McCaffrey T V, Atkinson J
Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Rhinol. 1998 Jul-Aug;12(4):283-7. doi: 10.2500/105065898781390028.
The transseptal/transsphenoidal approach to the pituitary gland has been the most commonly used approach for resection of pituitary adenomas for the last 50 years. This procedure has a low morbidity and provides direct midline access to the sella and pituitary gland. Recent advancements in endoscopic surgery, however, suggest that a lower morbidity approach to the sella would be possible via transnasal endoscopic route. Prior reports have confirmed effectiveness of this approach to the pituitary gland and we report here an early series of endoscopic transnasal pituitary surgery from our institution. We report seven cases of transnasal endoscopic pituitary surgery. Our technique consists of endoscopic exposure of the sphenoid ostium unilaterally, excision of the posterior septum anterior to the rostrum of the sphenoid sinus with resection of the sphenoid rostrum for bilateral exposure of the sphenoid sinus. A specially designed nasal speculum is positioned to displace the posterior septum and lateralize the middle turbinates, permitting direct midline exposure of the sphenoid sinus and sella. We have progressively modified the technique over the seven cases that we present and will discuss our specific instrumentation, indications, and technique for this procedure. We have encountered one cerebrospinal fluid leak in this series. Patient satisfaction has been high and hospitalization is less than with the conventional transseptal approach, averaging 1 day. Our impression is that the transnasal endoscopic approach to pituitary adenomas is a safe technique with reduced morbidity permitting shortened hospital stay.
在过去50年里，经鼻中隔/经蝶窦入路垂体手术一直是切除垂体腺瘤最常用的入路方法。该手术的发病率较低，能直接从正中进入蝶鞍和垂体。然而，内镜手术的最新进展表明，经鼻内镜入路有可能以更低的发病率进入蝶鞍。先前的报道已证实该入路垂体手术的有效性，在此我们报告本机构早期的一系列经鼻内镜垂体手术。我们报告了7例经鼻内镜垂体手术。我们的技术包括单侧内镜暴露蝶窦开口，切除蝶窦前结节前方的后鼻中隔，并切除蝶窦前结节以双侧暴露蝶窦。放置一个特制的鼻窥器来移位后鼻中隔并使中鼻甲向外侧移位，从而直接从正中暴露蝶窦和蝶鞍。在我们展示的7例病例中，我们逐步改进了技术，并将讨论该手术的具体器械、适应症和技术。在这一系列病例中，我们遇到了1例脑脊液漏。患者满意度较高，住院时间比传统经鼻中隔入路短，平均为一天。我们的印象是，经鼻内镜入路垂体腺瘤手术是一种安全的技术，发病率降低，住院时间缩短。
