导航下经蝶鞍底小骨窗硬脑膜小切口切除垂体微小病变

Under the Guidance of Transsphenoidal Sellar Dura Small Incision and Small Bone Window Resection of Pituitary Lesions

摘要: 导航的精准定位让经鼻蝶入路切除鞍区微小病变手术变得更加方便。我们在导航导引下尝试着经蝶鞍底小骨窗硬脑膜小切口切除垂体微小病变，取得了良好的效果。方法：自2015年9月至2016年7月间收治的垂体微小腺瘤病例30例，其中男性8例，女性22例，年龄从13~65岁。术前均进行内分泌功能检查，鞍区MRI平扫加薄层动态增强、MRV、冠状位CT加骨窗。病灶直径均小于10 mm。均采用右侧单鼻孔经蝶入路，行鞍底小骨窗硬脑膜小切口切除术。术后复查垂体相关激素水平，第三天复查蝶鞍MRI。结果：本组30例患者中促肾上腺皮质激素腺瘤5例，泌乳素腺瘤12例，生长激素腺瘤7例，Rathke囊肿6例。术中出血均在50 ml以下，均未输血。术中导航定位精确，准确发现肿瘤。术后复查内分泌功能指标均在正常值内。所有患者术后72 h内复查鞍区增强MRI，证实所有病灶均为全切。术后一过性尿崩5例，无脑脊液漏、视力下降、出血等其它并发症。平均术后住院日期为4天。所有患者随访3~13个月，平均8个月。随访内容为复查鞍区增强MRI，查血内分泌指标。所有患者均未见肿瘤残留或复发，术后内分泌指标均在正常范围内。结论：导航下经蝶鞍底小骨窗硬脑膜小切口切除垂体微小病变，能显著减少海绵窦、海绵间窦及颈内动脉的损伤，减少术中出血，更有利于垂体的功能保护，患者术后康复快，明显减少患者住院日期。

Abstract: The precise positioning of navigation makes it easier to operate via transsphenoidal approach for the removal of minor lesions in the saddle area. We tried to remove the pituitary microdisease through the small dural incision of the small bone window of the bottom of the sella under the guidance of navigation. Methods: From September 2015 to July 2016, 30 cases of pituitary microadenoma admitted in our department were treated, including 8 cases of male and 22 cases of female, aged from 13 - 65 years. The endocrine function was examined before operation, and the saddle area MRI plain scan with thin layer dynamic enhancement, MRV, coronal position CT plus bone window. All lesions were less than 10 mm in diameter. All of them were operated through right single nostril transsphenoidal approach with parsellar floor small bone window and dural small incision. After operation, the pituitary-related hormone levels were reviewed and by the third day, the MRI of the sella area was scanned. RESULTS: There were 5 cases of corticotropin adenoma, 12 cases of prolactin adenoma, 7 cases of growth hormone adenoma and 6 cases of Rathke cyst. All intraoperative bleeding was below 50 ml and no transfusion. During the operation, navigation helps us detect and position tumors accurately. After operation, the endocrine function indexes were all within the normal value. The enhancement MRI of the saddle area was re-examined within 72 h after operation in all patients, confirming that all lesions were fully cut. There were 5 cases of transient diabetes insipidus after operation, no cerebrospinal fluid leakage, visual acuity decline, bleeding and other complications. The average postoperative hospitalization date was 4 days. All patients were followed up for 3 - 13 months, with an average of 8 months. Follow-up content included saddle area enhancement MRI, blood endocrine index. All patients did not find tumor residue or recurrence, and the postoperative endocrine indexes were within the normal range. Conclusion: the new way of operation navigated by MRI can significantly reduce probability about the injury of the cavernous sinus, intercavernous sinuses and the internal carotid artery, reduce the intraoperative bleeding, and be more conducive to the functional protection of the pituitary gland.