多重技术在神经内镜下经鼻蝶垂体大腺瘤切除的应用  

Application of multiple techniques in endoscopic transnasal transsphenoidal resection of large pituitary adenomas

作　　者：黄进 孙骏 计巍 程超 焦建同 黄维一 邵君飞 Huang Jin;Sun Jun;Ji Wei;Cheng Chao;Jiao Jiantong;Huang Weiyi;Shao Junfei(Department of Neurosurgery,the Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi,Jiangsu 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院神经外科,江苏无锡214023

出　　处：《中国微侵袭神经外科杂志》2024年第2期81-85,共5页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：江苏省卫生健康委科研项目(编号:ZD2022038);无锡市太湖人才计划(编号:2020THRC-DJ-SNW);无锡市卫健委青年项目(编号:Q202133)。

摘　　要：目的探讨神经导航影像融合、假包膜外分离和术中个体化颅底修复技术在神经内镜下经鼻蝶垂体大腺瘤切除手术的应用价值。方法回顾性分析43例垂体大腺瘤的病例资料。术前行鞍区薄层CT、垂体MRI+MRA导航序列,利用神经导航影像融合重建技术进行术前评估。均行神经内镜下经蝶垂体瘤切除术,切开鞍底硬膜后,识别腺瘤周围的膜性结构,尽量沿假包膜外界面钝性分离,将假包膜与腺瘤一并切除。病人术中无脑脊液漏36例;低流量脑脊液漏4例,采用鞍底硬膜缝合、鼻外纱条支撑;术中有明显脑脊液漏2例,采用自体脂肪、阔筋膜、鞍底硬膜缝合;术中1例高流量脑脊液漏者,应用自体脂肪,可吸收人工脑膜,自体阔筋膜,带蒂鼻中隔黏膜瓣分层修补,间断缝合硬膜术后填塞瘤腔,最后予纱条支撑填塞鼻腔。结果所有病例未出现术后脑脊液鼻漏,出现一过性尿崩9例,颅内感染3例,均对症治疗后好转。肿瘤全切除39例,次全切除4例。术后3个月、6个月、1年复查MRI,39例全切病例未见复发,4例次全切病例中,3例无明显进展,1例接受再次手术,恢复良好。结论神经导航影像融合技术有助于手术医师评估肿瘤与周边结构位置关系,内镜下辨别腺瘤周围的膜性结构,颅底个体化修复技术效果确切,值得临床应用。Objective To explore the application value of neuronavigation image fusion,extracapsular dissection,and intraoperative individualized cranial base repair technique in endoscopic transnasal transsphenoidal resection of large pituitary adenomas.Methods The clinical data of 43 patients with large pituitary adenomas were analyzed retrospectively.Thin-slice CT of the sella region and pituitary MRI+MRA navigation sequences were performed,and preoperative evaluation was conducted using neuronavigation image fusion reconstruction technique.All the patients underwent endoscopic transsphenoidal pituitary adenoma resection.After incision of the dura of the sellar floor,the membranous structure around the adenoma was identified,and blunt dissection was performed along the extracapsular interface as much as possible.The pseudocapsule and adenoma were resected together.Among the patients,36 without cerebrospinal fluid leakage and 4 with low-flow cerebrospinal fluid leakage underwent suture of the sellar floor dura and nasal external gauze support,2 with obvious cerebrospinal fluid leakage during surgery were stratified repaired by autologous fat,fascia lata,and suture of the sellar floor dura and 1 case with high-flow cerebrospinal fluid leakage was treated with autologous fat,absorbable artificial dura,autologous fascia lata,and a pedicled nasal septal mucosal flap,with interrupted suturing of the dura and packing of the tumor cavity postoperatively,followed by nasal packing with gauze.Results No postoperative cerebrospinal fluid rhinorrhea occurred,transient diabetes insipidus was observed in 9 cases,and intracranial infection occurred in 3,all of which were improved after symptomatic treatment.Total tumor resection was achieved in 39 cases,and subtotal resection was in 4.Postoperative MRI was performed at 3 months,6 months,and 1 year postoperatively.No recurrence was observed in 39 cases of total resection.Among 4 cases of subtotal resection,3 showed no significant progression,and 1 case underwent reoperation with good reco

关 键 词：垂体肿瘤 神经内镜 假包膜 颅底重建 

分 类 号：R736.4[医药卫生—肿瘤]