[1]谢森,韩轶鹏,毛更生,等.术中MRI指导下经鼻蝶入路神经内镜手术治疗巨大无功能垂体腺瘤的疗效分析[J].中国临床神经外科杂志,2024,29(01):8-11.[doi:10.13798/j.issn.1009-153X.2024.01.003]
　XIE Sen,HAN Yi-peng,MAO Geng-sheng,et al.Efficacy of neuroendoscopic surgery via transsphenoidal approach under guidance of intraoperative MRI for patients with giant non-functional pituitary adenomas[J].,2024,29(01):8-11.[doi:10.13798/j.issn.1009-153X.2024.01.003]
点击复制

术中MRI指导下经鼻蝶入路神经内镜手术治疗巨大无功能垂体腺瘤的疗效分析()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
29
期数:
2024年01期
页码:
8-11
栏目:
论著
出版日期:
2024-01-30

文章信息/Info

Title:
Efficacy of neuroendoscopic surgery via transsphenoidal approach under guidance of intraoperative MRI for patients with giant non-functional pituitary adenomas
文章编号:
1009-153X（2024）01-0008-04
作者:
谢森; 韩轶鹏; 毛更生; 朱伟杰; 孟祥辉
100039北京，解放军总医院第三医学中心神经外科（谢森、韩轶鹏、毛更生）；100853北京，解放军总医院第一医学中心神经外科（朱伟杰、孟祥辉）；250031济南，联勤保障部队第960医院神经外科（朱伟杰）
Author(s):
XIE Sen1;  HAN Yi-peng1;  MAO Geng-sheng1;  ZHU Wei-jie2; 3;  MENG Xiang-hui2
1. Department of Neurosurgery, the Third Medical Center, Chinese PLA General Hospital, Beijing 100039, China; 2. Department of Neurosurgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China; 3. Department of Neurosurgery, the 960th Hospital, Joint Logistic Support Force, Jinan 250031, China
关键词:
垂体腺瘤; 神经内镜; 经鼻蝶入路; 术中MRI; 疗效
Keywords:
Giant non-functional pituitary adenomas;  Intraoperative MRI;  Endoscopic endonasal transsphenoidal surgery;  Efficacy
分类号:
R 739.41; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2024.01.003
文献标志码:
A
摘要:
目的 探讨术中MRI指导下经鼻蝶入路神经内镜手术治疗巨大（最大径>4 cm）无功能垂体腺瘤的疗效。方法 回顾性分析2009年2月至2015年6月经鼻蝶入路神经内镜手术治疗的24例巨大无功能垂体腺瘤的临床资料。术中使用MRI指导手术切除肿瘤。结果 肿瘤最大直径4~5 cm有18例，>5 cm有6例。术中MRI扫描1次15例，2次6例，3次2例，4次1例；平均（1.5±0.8）次/例。肿瘤全切除18例，次全切除6例。术中发现脑脊液鼻漏2例，术后出现脑脊液鼻漏1例、一过性尿崩6例；未出现颅内感染、颅内血肿。术后随访3~60个月，平均45个月；术后视力及视野改善19例，头痛缓解11例；新发垂体功能低下3例，嗅觉功能障碍4例，肿瘤复发2例。结论 术中MRI指导下经鼻蝶入路神经内镜手术是治疗巨大无功能垂体腺瘤安全有效的方式，能获得比较满意的疗效，手术安全性高、并发症少。
Abstract:
Objective To investigate the clinical efficacy of endoscopic endonasal transsphenoidal surgery (EETS) guided by intraoperative MRI (iMRI) for patients with giant (maximum diameter >4 cm) non-functional pituitary adenomas (NFPA). Methods The clinical data of 24 patients with giant NFPA treated by EETS from February 2009 to June 2015 were retrospectively analyzed. The iMRI was used to guide surgical resection of the tumors. Results The maximum tumor diameter was 4~5 cm in 18 patients and >5 cm in 6. The iMRI scan was performed in 15 patients for 1 time, 6 patients for 2 times, 2 patients for 3 times, and 1 patient for 4 times; with an average of (1.5±0.8) times/case. Total resection of the tumors was achieved in 18 patients and subtotal in 6. Cerebrospinal fluid (CSF) rhinorrhea occurred in 2 patients during the operation, and CSF rhinorrhea occurred in 1 and transient diabetes insipidus in 6 after the operation. There was no intracranial infection or intracranial hematoma. The postoperative follow-up ranged from 3 months to 60 months,with a mean time of 45 months. Impairments of visual acuity or visual field were improved in 19 of 24 patients, headache was relieved in 11 of 14 patients. Hypopituitarism occurred in 3 patients and olfactory dysfunction in 4, and tumors recurred in 2 patients during the follow-up. Conclusions EETS guided by iMRI is a safe and effective method for the treatment of patient with giant NFPA, which can obtain satisfactory efficacy, high surgical safety and few complications.

参考文献/References:

[1] MOONEY MA, SARRIS CE, ZHOU JJ, et al. Proposal and validationof a simple grading scale (TRANSSPHER Grade) for predictinggross total resection of nonfunctioning pituitary macroadenomasafter transsphenoidal surgery [J]. Oper Neurosurg (Hagerstown),2019, 17(5): 460-469.
[2] SCHERER M, ZERWECK P, BECKER D, et al. The value of intraoperative MRI for resection of functional pituitary adenomas--acritical assessment of a consecutive single center series of 114 cases[J]. Neurosurg Rev, 2022, 45: 2895-2907.
[3] HLAVác M, KNOLL A, MAYER B, et al. Ten years' experiencewith intraoperative MRI-assisted transsphenoidal pituitary surgery[J]. Neurosurg Focus, 2020, 48(6): E14.
[4] PALA A, KNOLL A, SCHNEIDER M, et al. The benefit of intraoperative magnetic resonance imaging in endoscopic and microscopic transsphenoidal resection of recurrent pituitary adenomas [J].Curr Oncol, 2022, 29: 392-401.
[5] PATEL A, DASTAGIRZADA Y, BENJAMIN C, et al. The value ofintraoperative magnetic resonance imaging in endoscopic endonasalresection of pituitary adenoma [J]. J Neurol Surg B Skull Base, 2022,83: 646-652.
[6] ELSHAZLY K, KSHETTRY VR, FARRELL CJ, et al. Clinical outcomes after endoscopic endonasal resection of giant pituitary adenomas [J]. World Neurosurg, 2018, 114: e447-e456.
[7] CASTA?O-LEON AM, PAREDES I, MUNARRIZ PM, et al. Endoscopic transnasal trans-sphenoidal approach for pituitary adenomas: a comparison to the microscopic approach cohort by propensity score analysis [J]. Neurosurgery, 2020, 86(3): 348-356.
[8] JUTHANI RG, REINER AS, PATEL AR, et al. Radiographic andclinical outcomes using intraoperative magn-etic resonance imagingfor transsphenoidal resection of pituitary adenomas [J]. J Neurosurg,2021, 134: 1824-1835.
[9] SONERU CP, RILEY CA, HOFFMAN K, et al. Intraoperative MRIvs endoscopy in achieving gross total resection of pituitary adenomas: a systematic review [J]. Acta Neurochir (Wien), 2019, 161:1683-1698.
[10] ZAIDI HA, DE LOS REYES K, BARKHOUDARIAN G, et al. Theutility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experiencein the Advanced Multimodality Image Guided Operating suite [J].Neurosurg Focus, 2016, 40(3): E18.
[11] FOMEKONG E, DUPREZ T, DOCQUIER MA, et al. Intraoperative3T MRI for pituitary macroadenoma resection: initial experience in73 consecutive patients [J]. Clin Neurol Neurosurg, 2014, 126: 143149.
[12] MENG XH, XU BN, WEI SB, et al. Dual room high-field intraoperative magnetic resonance imaging suite with a movable magnet:implementation and preliminary experience in pituitary adenomaoperation through transsphenoidal approach [J]. Chin J Neurosurg,2010, 26(4): 310-313.孟祥辉，许百男，魏少波，等. 移动磁体双室高场强术中磁共振成像系统在经蝶窦垂体腺瘤手术中的初步应用[J]. 中华神经外科杂志，2010，26（4）：310-313.
[13] SYLVESTER PT, EVANS JA, ZIPFEL GJ, et al. Combined highfield intraoperative magnetic resonance imaging and endoscopyincrease extent of resection and progression-free survival forpituitary adenomas [J]. Pituitary, 2015, 18(1): 72-85.
[14] TANJI M, KATAOKA H, KIKUGHI M, et al. Impact of Intraoperative 3-Tesla MRI on endonasal endoscopic pituitary adenomaresection and a proposed new scoring system for predicting theutility of intraoperative MRI [J]. Neurol Med Chir (Tokyo), 2020, 60:553-562.
[15] WANG YF, YAN HY, HANG CH, et al. Transnasal endoscopic surgery combined with micro-surgery via supraorbital lateral approachfor patients with large pituitary adenoma [J]. Chin J Clin Neurosurg,2022, 27(12): 961-963.王云锋，闫惠颖，杭春华，等. 经鼻蝶入路神经内镜手术联合眶上外侧入路显微手术治疗大型垂体腺瘤[J]. 中国临床神经外科杂志，2022，27（12）：961-963.[16] DUSICK JR, ESPOSITO F, MATTOZO CA, et al. Endonasal transsphenoidal surgery: the patient's perspective-survey results from259 patients [J]. Surg Neurol, 2006, 65(4): 332-341.
[17] ZADA G, KELLY D, COHAN P, et al. Endonasal transsphenoidalapproach for pituitary adenomas and other sellar lesions: all assessment of emcacy, safety, and patient impressions [J]. J Neurosurg,2003, 98(2): 350-358．

相似文献/References:

[1]余龙洋　李亚楠　周　宇　戴冬伟　曹依群　岳志健.垂体腺瘤经蝶术后并发蛛网膜下腔出血的临床分析 （附6例报道）[J].中国临床神经外科杂志,2016,(06):372.[doi:10.13798/j.issn.1009-153X.2016.06.018]
[2]张海红　马　磊　张　威　郭　康　衡立君　贾　栋.垂体腺瘤MRI特征与视觉功能损害的关系分析[J].中国临床神经外科杂志,2016,(01):27.[doi:10.13798/j.issn.1009-153X.2016.01.010]
　ZHANG Hai-hong,MA Lei,ZHANG Wei,et al.Analysis of MRI characteristics and visual function in patient with pituitary adenomas[J].,2016,(01):27.[doi:10.13798/j.issn.1009-153X.2016.01.010]
[3]马　涛　徐　韬.经蝶入路内镜手术与显微手术治疗垂体腺瘤疗效的Meta分析[J].中国临床神经外科杂志,2015,(12):748.[doi:10.13798/j.issn.1009-153X.2015.12.015]
[4]雷　霆.注重基础训练和知识更新，不断提高垂体腺瘤诊疗水平[J].中国临床神经外科杂志,2015,(10):577.[doi:10.13798/j.issn.1009-153X.2015.10.001]
[5]闫　进　李　松　杨　辉.1H-MRS对卵泡刺激素免疫阳性垂体腺瘤的诊断和预后评估的价值[J].中国临床神经外科杂志,2015,(10):588.[doi:10.13798/j.issn.1009-153X.2015.10.004]
　YAN Jin,LI Song,YANG Hui..Value of 1H-MRS to diagnosis and assessment of prognoses in patients with non-functioning gonadotroph adenomas[J].,2015,(01):588.[doi:10.13798/j.issn.1009-153X.2015.10.004]
[6]向兴刚　张永辉　李大志　昝向阳　于晓晨　蔡　宁　赵　永　林　琳.神经内镜辅助微血管减压术治疗面肌痉挛疗效分析[J].中国临床神经外科杂志,2015,(10):624.[doi:10.13798/j.issn.1009-153X.2015.10.015]
[7]张　锟　尹晓亮　刘　磊　董雪涛　张新庆.神经内镜手术治疗高血压脑出血临床观察[J].中国临床神经外科杂志,2015,(08):483.[doi:10.13798/j.issn.1009-153X.2015.08.013]
[8]罗　明　杨国平　段发亮　闵　强.神经导航辅助内镜手术治疗高血压脑出血52例[J].中国临床神经外科杂志,2015,(06):374.[doi:10.13798/j.issn.1009-153X.2015.06.021]
[9]王齐齐　陈　俊　王焕明　胡　飞.脊索瘤合并垂体腺瘤1例[J].中国临床神经外科杂志,2015,(07):448.[doi:10.13798/j.issn.1009-153X.2015.07.025]
[10]秦　汉　胡军民　秦海林　别毕洲　向伟楚　秦尚振　马廉亭.MRI与Dyna-CTA融合影像结合神经导航在经鼻蝶垂体腺瘤切除术中的应用[J].中国临床神经外科杂志,2015,(09):513.[doi:10.13798/j.issn.1009-153X.2015.09.001]
　QIN Han,HU Jun-ming,QIN Hai-lin,et al.Application of MRI and CTA fusion images combined with neuronavigation to transsphenoidal microsurgery for pituitary adenomas[J].,2015,(01):513.[doi:10.13798/j.issn.1009-153X.2015.09.001]
[11]王国良　高　寒　张小鹏　公方和　李天栋.89例垂体腺瘤的手术治疗体会[J].中国临床神经外科杂志,2016,(07):435.[doi:10.13798/j.issn.1009-153X.2016.07.016]
[12]王亚平　贾晓雄　王　珺　王林林　谭溢涛　马德得　夏鹤春.神经内镜下与显微镜下经鼻蝶入路手术切除垂体腺瘤的疗效对比分析[J].中国临床神经外科杂志,2016,(03):145.[doi:10.13798/j.issn.1009-153X.2016.03.004]
　WANG Ya-ping,JIA Xiao-xiong,WANG-Jun,et al.Resection of pituitary adenomas by endoscopic and microscopic surgery via transnasal transsphenoidal approach: a comparative analysis[J].,2016,(01):145.[doi:10.13798/j.issn.1009-153X.2016.03.004]
[13]王先祥　张义泉　李庆新　王　斌　 肖　瑾　张　科.经单鼻孔蝶窦入路神经内镜下切除垂体腺瘤[J].中国临床神经外科杂志,2015,(12):715.[doi:10.13798/j.issn.1009-153X.2015.12.004]
　WANG Xian-xiang,ZHANG Yi-quan,LI Qing-xin,et al.Endoscopic endonasal transsphenoidal surgery for pituitary adenomas[J].,2015,(01):715.[doi:10.13798/j.issn.1009-153X.2015.12.004]
[14]夏为民　邵耐远　唐　科.神经内镜辅助经鼻蝶入路手术治疗急性垂体腺瘤卒中[J].中国临床神经外科杂志,2015,(07):437.[doi:10.13798/j.issn.1009-153X.2015.07.020]
[15]苏卢海　张世渊　胡昌辰　沈　波.神经导航辅助内镜下经鼻蝶入路手术治疗垂体腺瘤的疗效观察[J].中国临床神经外科杂志,2015,(09):549.[doi:10.13798/j.issn.1009-153X.2015.09.013]
[16]陈姣红　张红波　郑　虎　宗绪毅.内镜下经鼻蝶入路切除ACTH垂体腺瘤术后观察及护理[J].中国临床神经外科杂志,2017,(11):787.[doi:10.13798/j.issn.1009-153X.2017.11.020]
[17]郭爱顺　陈寿仁　林瑞生.内镜下经蝶入路手术切除垂体大腺瘤80例[J].中国临床神经外科杂志,2018,(01):31.[doi:10.13798/j.issn.1009-153X.2018.01.011]
[18]李承科　何　琴　唐　辉　冯　浩　付安辉.垂体腺瘤术后外周血T淋巴细胞亚群及血清MMP-9水平的变化[J].中国临床神经外科杂志,2018,(02):87.
　LI Chengke,HE Qin,TANG Hui,et al.Effects of neuroendoscope-assisted surgery via single-nostril transsphenoidal approach for pituitary adenomas on the levels of peripheral blood T lymphocyte subsets and serum MMP-9[J].,2018,(01):87.
[19]赵彬芳　贺世明　李明娟　曹娅妮　杨丽辉　郑　涛.神经内镜经鼻蝶垂体腺瘤日间手术12例临床分析[J].中国临床神经外科杂志,2018,(12):811.[doi:10.13798/j.issn.1009-153X.2018.12.018]
[20]肖　瑾　王卫红　毛忠祥　程宏伟　王先祥　李志范　王　斌　张义泉.多种技术辅助切除伴复杂蝶窦的垂体腺瘤[J].中国临床神经外科杂志,2019,(02):102.[doi:10.13798/j.issn.1009-153X.2019.02.012]

备注/Memo

备注/Memo:
（2023-05-25收稿，2023-09-15修回） 通讯作者：朱伟杰，E-mail：zhuweijie66@163.com 孟祥辉，E-mail：18612357799@163.com
更新日期/Last Update: 2024-01-30