术中MRI指导下经鼻蝶入路神经内镜手术治疗巨大无功能垂体腺瘤的疗效分析
Efficacy of neuroendoscopic surgery via transsphenoidal approach under guidance of intraoperative MRI for patients with giant non-functional pituitary adenomas
谢森 1韩轶鹏 1毛更生 1朱伟杰 2孟祥辉3
作者信息
- 1. 100039 北京,解放军总医院第三医学中心神经外科
- 2. 100853 北京,解放军总医院第一医学中心神经外科;250031 济南,联勤保障部队第960医院神经外科
- 3. 100853 北京,解放军总医院第一医学中心神经外科
- 折叠
摘要
目的 探讨术中MRI指导下经鼻蝶入路神经内镜手术治疗巨大(最大径>4 cm)无功能垂体腺瘤的疗效.方法 回顾性分析2009年2月至2015年6月经鼻蝶入路神经内镜手术治疗的24例巨大无功能垂体腺瘤的临床资料.术中使用MRI指导手术切除肿瘤.结果 肿瘤最大直径4～5 cm有18例,>5 cm有6例.术中MRI扫描1次15例,2次6例,3次2例,4次1例;平均(1.5±0.8)次/例.肿瘤全切除18例,次全切除6例.术中发现脑脊液鼻漏2例,术后出现脑脊液鼻漏1例、一过性尿崩6例;未出现颅内感染、颅内血肿.术后随访3～60个月,平均45个月;术后视力及视野改善19例,头痛缓解11例;新发垂体功能低下3例,嗅觉功能障碍4例,肿瘤复发2例.结论 术中MRI指导下经鼻蝶入路神经内镜手术是治疗巨大无功能垂体腺瘤安全有效的方式,能获得比较满意的疗效,手术安全性高、并发症少.
Abstract
Objective To investigate the clinical efficacy of endoscopic endonasal transsphenoidal surgery(EETS)guided by intraoperative MRI(iMRI)for patients with giant(maximum diameter>4 cm)non-functional pituitary adenomas(NFPA).Methods The clinical data of 24 patients with giant NFPA treated by EETS from February 2009 to June 2015 were retrospectively analyzed.The iMRI was used to guide surgical resection of the tumors.Results The maximum tumor diameter was 4～5 cm in 18 patients and>5 cm in 6.The iMRI scan was performed in 15 patients for 1 time,6 patients for 2 times,2 patients for 3 times,and 1 patient for 4 times;with an average of(1.5±0.8)times/case.Total resection of the tumors was achieved in 18 patients and subtotal in 6.Cerebrospinal fluid(CSF)rhinorrhea occurred in 2 patients during the operation,and CSF rhinorrhea occurred in 1 and transient diabetes insipidus in 6 after the operation.There was no intracranial infection or intracranial hematoma.The postoperative follow-up ranged from 3 months to 60 months,with a mean time of 45 months.Impairments of visual acuity or visual field were improved in 19 of 24 patients,headache was relieved in 11 of 14 patients.Hypopituitarism occurred in 3 patients and olfactory dysfunction in 4,and tumors recurred in 2 patients during the follow-up.Conclusions EETS guided by iMRI is a safe and effective method for the treatment of patient with giant NFPA,which can obtain satisfactory efficacy,high surgical safety and few complications.
关键词
垂体腺瘤/神经内镜/经鼻蝶入路/术中MRI/疗效Key words
Giant non-functional pituitary adenomas/Intraoperative MRI/Endoscopic endonasal transsphenoidal surgery/Efficacy引用本文复制引用
出版年
2024
NETL
NSTL
万方数据