CT仿真内镜在垂体微腺瘤经蝶显微手术的应用  

CT virtual endoscopy for transsphenoidal microsurgical treatment of pituitary microadenomas

作　　者：蔡梅钦[1] 李文胜[1] 王辉[1] 胡冰[2] 石德金[1] 何海勇[1] 陈少琼[2] 郭英[1] 

机构地区：[1]中山大学附属第三医院神经外科,垂体瘤中心,广州510630 [2]中山大学附属第三医院放射科

出　　处：《中华显微外科杂志》2009年第5期374-377,I0003,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨CT仿真内镜（CT virtual endoscopy，CTVE）在垂体微腺瘤经蝶显微手术中的应用价值。方法在18例垂体微腺瘤经蝶手术中，对常规术前垂体CT检查数据进行CTVE重建，并用于指导术前计划、术中定位。对CTVE显示的鞍底三维图像与术中显微镜所见图像进行比较。结果CTVE能以三维图像形式显示鞍底解剖结构，对表面结构：蝶窦内隔、鞍底、颈内动脉隆起、视神经管隆起、视神经管一颈内动脉隐窝的显示率分别为344．4％、100％、41．7％、36．1％、58．3％，显示范围较较术中显微镜大。通过透视功能或调高观察阈值，CTVE能显示鞍底深面的颈内动脉、垂体组织、部分视神经管，通过二维图像，能准确的标出肿瘤在CTVE图像上的位置。CTVE能反复模拟手术入路及部分经蝶手术过程。结论CTVE能显示蝶窦及鞍底的表面解剖标志同深面结构的三维解剖关系。在垂体微腺瘤经蝶手术中，CTVE能指导术前计划形成及术中定位。Objective To evaluate the value of CT virtual endoscopy （CTVE） for microsurgery of pituitary microadenomas via transsphenoidal approach. Methods In 18 patients with pituitary microadenomas underwent microsurgery via transsphenoidal approach, the presurgical CT data was transfered to work station, the anatomies of the sphenoid sinus were then reconstructed by CTVE. The CTVE images were used to make the preoperative planning and indentify sphenoid sinus, sellar floor, and the position of the tumor during surgery. The CTVE images and the views from iutraoperative microscope were compared. Results CTVE could display the anotomoties of sphenoid sinus in a three-dimentional mode. The display rates of superfical antomies such as sphenoid septa, sellar floor, carotid prominence, optic prominence and opticocarotid recess were 344.4%, 100%, 41.7%, 36.1% and 58.3% respectively and the visual fields of these anatomic landmarks were larger than the views from the intraoperative microscope. CTVE could depcit the anatomies of the enhanced carotid ateries and pituitary tissue and some optic canals underlying the seflae by transparent function or heighten the threshold. The sites of the tumor could be marked correctly on CTVE images. CTVE could simulate the operative approach and some operating procedures preoperatively. Conclusion CTVE can display the anatomies of sphenoid sinus in a three-dimensional mode. In transsphenoidal treatment of pituitary microadenoma, CTVE can help to make preoperative planning, locate the intraoperative structures and make a precise bone window during surgery.

关 键 词：CT仿真内镜 显微手术 经蝶入路 垂体 微腺瘤 

分 类 号：R736.4[医药卫生—肿瘤]