伴有脑积水的无功能巨大垂体腺瘤的治疗方法  

Treatment strategies of giant nonfunctioning pituitary adenomas with obstructive hydrocephalus

作　　者：毛志钢[1] 王宗明[1] 罗柏宁[2] 廖志红[3] 何东升[1] 冯子泽[1] 胡斌[1] 王霁雯 蒋小兵[1] 王海军[1] 

机构地区：[1]中山大学附属第一医院神经外科、垂体瘤诊治中心, 广州510080 [2]中山大学附属第一医院放射科,广州510080 [3]中山大学附属第一医院内分泌科,广州510080

出　　处：《中华神经外科杂志》2014年第10期1000-1004,共5页Chinese Journal of Neurosurgery

基　　金：基金项目：教育部博士点基金（20110171120067）

摘　　要：目的 探讨巨大无功能垂体腺瘤（NFPA）伴梗阻性脑积水的治疗方法和疗效。方法 回顾性分析41例巨大NFPA伴梗阻性脑积水患者的临床资料,经蝶窦手术28例,共进行36次经蝶窦手术（包括再次和分次经蝶窦手术）,其中唇下鼻中隔蝶窦入路19次,鼻中隔蝶窦入路17次.翼点开颅入路13例。结果 肿瘤全切率61％ （25/41）,其中经蝶窦入路61％（17/28）、开颅62％ （8/13）,再次经蝶窦入路50％ （4/8）.脑室外引流术8例,其中术前4例为2007年前病例,脑室外引流拔管后,3例脑积水缓解,1例肿瘤残留脑积水未缓解行分流术;术后4例（开颅2例、经蝶窦2例）,2例瘤腔出血致急性梗阻性脑积水,2例颅内感染后脑积水。所有病例中,5例术后脑积水未缓解需行脑室-腹腔分流术.结论 巨大NFPA梗阻性脑积水的治疗应根据肿瘤的生长方式、鞍底形状等选择手术入路,经蝶窦入路可取得较好疗效,对不适宜经蝶窦入路者可选择开颅、经蝶窦开颅联合入路或分期手术.应根据脑积水的程度和临床症状合理选择术前脑室外引流术和分流术。Objective To analyze the treatment strategies of obstructive hydrocephalus caused by giant nonfunctioning pituitary adenomas （NFPA）.Methods The clinical data of 41 cases of NFPA with obstructive hydrocephalus were analyzed retrospectively.Twenty-eight cases were treated through transsphenoidal approach.36 transsphenoidal procedures were carried out,including 19 sub-lip nasal septum sphenoidal sinus approach procedures and 17 nasal septum sphenoidal sinus approach procedures.The pterional craniotomies were used in 13 cases.Results Twenty-five tumors were totally removed,and the overall resection rate was 61%.The total resection rate was 61% （17/28） in transsphenoidal approach and 62% （8/13） in pterional craniotomy approach,respectively.The total resection rate was 50% （4/8） in two-stage of transsphenoidal approach.The external ventricular drainage was used in 8 cases.Among them,4 procedures were performed preoperatively before 2007.The obstructive hydrocephalus was relieved in 3 cases after extracting the external ventricular drainage,and ventricles-peritoneal shunt was used in the other case because of the residual tumor.Another 4 cases were done postoperatively after 2007,including 2 cases of transsphenoidal approach and 2 cases of pterional craniotomy approach.The obstructive hydrocephalus was unrelieved in these 4 cases,including 2 cases were tumor cavity hematoma and 2 cases were tumor residual.Of all the cases,the cerebral ventricles-peritoneal shunt was used in 5 cases.Conclusions The treatment strategies of NFPA with obstructive hydrocephalus should select suitable operative approaches according to the shape and size of sellar floor,growth pattern,texture and blood supply of tumors.The transsphenoidal microsurgery was the primitive approach and could get good surgical effects.The pterional craniotomy,combined with the transsphenoidal and craniotomy,and two-stage of transsphenoidal approach were used in unsuitable transsphenoidal approach cases.The preoperative external ventricular drainage

关 键 词：垂体腺瘤 梗阻性脑积水 经蝶窦手术 翼点开颅手术 

分 类 号：R736.4[医药卫生—肿瘤]