临床神经外科杂志2016，Vol.13Issue(2)：98-101,4.DOI:10.3969/j.issn.1672-7770.2016.02.006
神经内镜经鼻蝶窦垂体瘤手术鞍底重建策略
Strategy of sellar floor reconstruction about neuroendoscopic transnasal sphenoid pituitary adenoma surgery
摘要
Abstract
Objective To explore the strategy of sellar floor reconstruction about neuroendo-scopic transnasal sphenoid pituitary adenoma surgery.Methods The clinical data of 165 patients of neuroendoscopic transnasal sphenoid sinus pituitary tumor surgery were analyzed retrospectively.The sellar floor reconstruction surgical techniques and surgical strategies were summarized.Based on the degree of intraoperative CSF leakage, we adopted classification scheme in sellar floor reconstruction. (1) The integrity of saddle diaphragm was protected,There is no need to sellar floor reconstruction. If large pituitary adenoma with skull defects,sellar reconstruction was necessary.Autologous fat local packing and artificial dura mater repair.( 2 ) Local small leakage with intraoperative saddle diaphragm, there must be sellar floor reconstruction.The reserved fat packing and artificial dura mater repair,the mucosal flap with vascular pedicle lay over sellar floor.( 3 ) Large leakage with intraoperative saddle diaphragm,Gasket seal technology was used to close sellar floor.The mucosal flap with vascular pedicle lay over sellar floor.Fibrin glue application.Results The integrity of the saddle diaphragm was protected in 114 ( 69.1%) cases, which were applied in type 1 repair method.49 cases (29.7%) appeared small break in the saddle diaphragm, these patients were applied in type 2 method.2 (1.2%) occurred large break in saddle diaphragm,the 2 were applied in type 3 method.5 presented transient after operation.4 were cured by conservative treatment.1 patient remained CSF two weeks after conservative treatment.This patient was healed with endoscopictranssphenoidal sellar floor repair surgery.Patients followed up for 6 months to 5 years, 1 patient recurrened with cerebrospinal fluid leakage caused by fell after one year of pituitary tumor surgery. With flat bed rest and lumbar drainage, the patient was healed well.Conclusions Preoperative assessment thickness of saddle diaphragm,intraoperative assessment the extent of CSF,are beneficial to the choice of surgical options.Classification scheme in sellar floor reconstruction helps to improve surgery,reduce postoperative complications of cerebrospinal fluid leakage .关键词
神经内镜/垂体瘤/鞍底重建Key words
neuroendoscopic/pituitary adenoma/sellar floor reconstruction分类
医药卫生引用本文复制引用
严正村,张恒柱,王晓东,佘磊,董伦..神经内镜经鼻蝶窦垂体瘤手术鞍底重建策略[J].临床神经外科杂志,2016,13(2):98-101,4.基金项目
2013年"六大人才高峰"项目( WSN-022 ) ,2015 年扬州市重点研发计划(YZ2015046) （ WSN-022 ）
