CAJ | 학술논문

目的探讨经颅切除巨大侵袭型垂体腺瘤视神经微血管解剖及保护视功能的显微手术策略.方法对35例巨大侵袭型垂体腺瘤患者,根据术前影像学资料选用不同的手术入路,术中经鞍区不同解剖腔隙显微镜下先行瘤内切除肿瘤,瘤内空虚后再分离视神经,注意保护供应视神经、视神经交叉的微血管.结果 35例中肿瘤全切除25例,次全切除10例.术中视神经均解剖保护,视力好转20例,无变化2例,无改善7例,加重6例.结论选择合理的手术入路是巨大垂体腺瘤手术成功的前提,熟练掌握鞍区的微血管解剖,重视术中对视神经、视神经交叉及其微血管的保护和娴熟的显微手术技术是避免术中视神经损伤,减少术后视力、视野障碍的关键.
목적 탐토경로절제거대침습형수체선류시신경미혈관해부급보호시공능적현미수술책략.방법 대35례거대침습형수체선류환자,근거술전영상학자료선용불동적수술입로,술중경안구불동해부강극현미경하선행류내절제종류,류내공허후재분리시신경,주의보호공응시신경、시신경교차적미혈관.결과 35례중종류전절제25례,차전절제10례.술중시신경균해부보호,시력호전20례,무변화2례,무개선7례,가중6례.결론 선택합리적수술입로시거대수체선류수술성공적전제,숙련장악안구적미혈관해부,중시술중대시신경、시신경교차급기미혈관적보호화한숙적현미수술기술시피면술중시신경손상,감소술후시력、시야장애적관건.
Objective To explore the anatomy of optic microvascular and the transcranial microsurgicaloperative strategies for protection of optic nerve function during the operation of the resection of giant invasivepituitary adenoma.Methods Thirty-five patients with giant pituitary adenoma were treated by different surgicalapproaches according to preoperative imaging data.The tumors were removed by employing microsurgicaltechnique via the parachiasmal opticocarotid and carotidotentorial spaces in sellar region and by opening thelamina terminals.Much attention was given to the preservation of perforating arteries from the interal carotidartery,anterior and posterior communicating arteries and arterior choroidal artery to optic nerve and chiasmResults Total removal of tumors Was conducted in 25 cases.Subtotal removal was performed in 10cases.Anatomical preservation of the optic nerve was achieved in all the cases during the operation,with opticnerve function getting better in 20 cases,remaining unchanged in 2 cases,no improvement in 7 cases and gettingworse in 6 cases.Conclusion A reasonable surgical approach is a prerequisite for the giant invasive pituita~adenoma surgery.Understanding the anatomical characteristics of microvascular in the sellar region,carefulprotection of the optic nerve,optic chiasm and microvascular,skilled microsurgical technique during the operationis key to prevent post-operative complications of optic nerve function.