鼻內視鏡經蝶竇移除巨大腦下垂體腺瘤

Endoscopic Transsphenoidal Removal of a Huge Pituitary Adenoma

邱贊仁(Tsan-Jen Chiu) ； 李定洲(Tin-Chou Li) ； 劉嘉銘(Chia-Ming Liu)

《台灣耳鼻喉頭頸外科雜誌》 45卷5期 (2010/10) Pp. 145-149

https://doi.org/10.6286/2010.45.5.145

摘要

巨大腦下垂體腺瘤臨床上少見，多由不具分泌性的腺瘤形成，因視神經、腦室受到腫瘤壓迫，常造成失明、視野喪失、水腦症而危害生命。巨大腦下垂體腺瘤的治療以手術爲主，因手術技巧困難，以往常需使用顱骨切開術移除巨大腺瘤，但其風險性高。本病例爲1名18歲男性，因頭痛及視力逐漸下降至本院求診，病人1年前曾於外院手術但未成功，在本院耳鼻喉科及神經外科合作下，採內視鏡經鼻內路徑，配合影像導航系統，使用雙外科醫師手術技巧(two-surgeon technique)，在雙手手術的模式下移除腫瘤，並利用腫瘤外圍包膜，填補蝶鞍骨質及硬腦膜缺損，避免術後腦脊液滲漏。追蹤迄今3年10個月，情況良好。

關鍵字

內視鏡 ； 影像導航手術 ； 腦下垂體腺瘤 ； 顱底手術 ； 雙外科醫師手術技巧

並列摘要

A huge pituitary tumor is rare and is usually a non-secretory adenoma. It may cause severe complications such as impairment of vision, visual field loss and obstructive hydrocephalus. Surgical removal is the mainstay treatment for a non-secretory adenoma. Surgery via transcranial route was used for the huge pituitary tumor before, but it had higher surgical risk. We experienced an 18-year-old man complaining of headache and progressive visual impairment. He had received surgery for the huge pituitary tumor at other hospital one year ago. However, the symptoms failed to improve and MRI showed a persistent huge pituitary tumor. Endonasal approach to the pituitary gland through the sphenoid sinus with computer-assisted navigation guide was performed by an otolaryngologist and a neurosurgeon. The two-surgeon transnasal technique allowed the huge pituitary tumor to be removed endoscopically. After removing the tumor, its capsule was pulled down to fill the sellar cavity as a barrier to prevent cerebrospinal fluid leakage. The post-operative course was uneventful till now.

並列關鍵字

endoscope ； image-guided surgery ； pituitary adenoma ； skull base surgery ； two-surgeon technique