经颅鞍区肿瘤切除术中垂体柄的辨认与保护  

Identification and protection strategy of pituitary stalk during microsurgery of sellar region tumors

作　　者：李爱军[1] 兰青[1] 王道奎[2] 曹培成[2] 刘维生[2] 刘国栋[1] 

机构地区：[1]苏州大学附属第二医院神经外科,215004 [2]山东省潍坊市人民医院神经外科

出　　处：《中华神经外科杂志》2013年第11期1160-1163,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨经颅切除鞍区肿瘤术中垂体柄的保护策略。方法回顾性分析110例鞍区肿瘤的临床资料，采用翼点入路34例，额底入路21例，眶上入路20例，纵裂入路35例（额底纵裂入路26例，纵裂终板入路9例）。结果垂体腺瘤47例，全切除42例，垂体柄完好保留44例，2例部分保留，1例未发现。颅咽管瘤38例，全切除32例，垂体柄完好保留27例，解剖保留或部分保留7例，未发现4例。脑膜瘤25例，全切除23例，垂体柄保留24例，1例解剖保留。经，检验肿瘤的性质不同垂体柄完全保留率存在差异（P〈0．05）。结论肿瘤的性质直接影响垂体柄的保留率，选择恰当的手术入路及娴熟的手术技巧，对垂体柄的辨认和保护至关重要。Objective To study the protection strategy of pituitary stalk via transcranial approach for sellar tumors resection. Methods Retrospective analysis of the clinical data of 110 patients with sellar region tumors was performed. Craniotomy was performed via the pterional approach in 34 cases, the subfrontal approach in 21 cases, the supraorbital keyhole approach in 20 cases, the interhemispheric approach in 35 cases （ the fronto - basal interhemispheric approach in 26 patients, and the anterior interhemispheric approach through the lamina terminalis in 9 patients）. Results In 47 cases with pituitary adenoma , the tumors were totally resection in 42 cases, the pituitary stalks were preserved in 44 cases, partly retained in 2 and not founded in 1. In 38 cases with craniopharyngioma, the tumors were totally removed in 32 cases. The pituitary stalks were preserved in 27 cases, and partly retained in 7 cases and not founded in 4. In 25 patients with Meningioma, the tumors were totally removed in 23 cases, the pituitary stalks were preserved in 24 cases （ P 〈 0. 05 ）. Conclusions The nature of tumors directly affect the retention rate of pituitary stalk , so we should choose appropriate surgical approach and skilled microsurgical techniques which play an important role in the identification and protection of pituitary stalk.

关 键 词：垂体柄 鞍区肿瘤 开颅术 显微外科手术 

分 类 号：R739.4[医药卫生—肿瘤]