经鼻蝶向鞍底两侧扩大切除侵入海绵窦的垂体腺瘤20例报告

摘要

Objective To explore the feasibility of extended resection through transsphenoidal approach for pituitary adenoma invading the cavernous sinus. Methods The sphenoid ventral wall was exposed via a single nostril approach, and then was completely removed to expose the sphenoid sinus. Afterwards, the mucosa and septum of the sphenoid sinus were removed to expose the floor of the sellar turcica, so that to make radial incisions on the dura mater and remove the tumor tissues on the sellar floor. And then, with the center of the retractor pointing at the invaded cavernous sinus, the ventral wall and dura mater of the cavernous sinus were cut to remove the tumor tissues inside. Results In the 20 patients, the tumor tissues were completely removed in 18 cases, and partially removed in the other 2. Cerebrospinal fluid leakage occurred during the operation in 2 patients, who was then cured by stuffing gelatin sponge into the intrasellar space and sphenoid sinus. One patient developed transient oculomotor nerve palsy and was then recovered in 3 months. Twelve patients had transient diabetes insipidus and 6 patients showed transient electrolyte disorder after the operation, all of them recovered in 1 week. Two patients developed cerebrospinal fluid leakage in half a month after being discharged, and was cured by trans-lumbar drainage for 1 week. A mean of 20 months (3 -36 months) follow-up was achieved in 18 patients, during the period, no patients had recurrence. Conclusion Extended resection of pituitary adenoma invading the cavernous sinus via transsphenoidal approach and by expanding both sides of the sellar floor leads to a satisfactory exposure, complete resection without severe operative complications.%目的 探讨采用经鼻蝶向鞍底两侧扩大切除侵入海绵窦的垂体腺瘤的可行性.方法 经单鼻孔显露蝶窦腹侧壁,蝶窦腹侧壁充分咬除,进入蝶窦,去除蝶窦黏膜和蝶窦隔,显露鞍底,鞍底开窗,放射状切开鞍底硬膜,切除鞍内肿瘤组织后,将牵开器的中心部分指向所侵入的海绵窦方向,咬骨钳咬除或磨钻磨除海绵窦腹侧骨质,显露海绵窦腹侧硬脑膜,自鞍底硬膜切开部分向外侧切开海绵窦腹侧硬脑膜,显露并切除海绵窦内部分肿瘤.结果 肿瘤全部切除18例,次全切除2例.术中出现2例脑脊液漏,应用明胶海绵鞍内及蝶窦内填塞,术后无脑脊液漏.术后出现一过性动眼神经麻痹1例,术后3个月恢复正常.术后出现一过性尿崩12例,一过性电解质紊乱6例,均在1周内恢复正常.术后出院半个月后出现2例脑脊液鼻漏,行腰穿置管引流1周治愈.18例随访3～36个月,平均20个月,肿瘤无复发.结论 采用经鼻蝶向鞍底两侧扩大切除侵人海绵窦的垂体腺瘤显露满意,切除彻底,无明显手术并发症.