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The Comparison of Endoscopic Anatomy and Microsurgical Anatomy through Transsphenoidal Approach to Sellar Region and Its Clinical Application

Author: LiuZuo
Tutor: WangYeZhong
School: Shihezi University
Course: Surgery
Keywords: Neuroendoscopy Microscope Transsphenoidal approach Saddle area Neurosurgery surgery Pituitary adenomas
CLC: R736.4
Type: Master's thesis
Year: 2009
Downloads: 14
Quote: 0
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Abstract


The first part of transsphenoidal approach to the comparison of the anatomy and microscopic anatomy of the sellar region mirror Objective: To observe the endoscopic and microscopic transsphenoidal approach to the anatomy of the sellar region structure under endoscope and microscope revealed differences determine related surgery flags; master the knowledge of the microscopic anatomy and endoscopic anatomy of the sellar region, to help carry out endoscopic assisted transsphenoidal pituitary tumor resection surgery. Methods: Formalin-fixed adult cadaveric head specimens 8 After soaking, rinse and perfusion observe the relationship between the local the saddle area structure position. Alternate use of endoscopic and microscopic transsphenoidal approach revealed. Determine under the microscope, and the microscope transsphenoidal approach to the saddle area of ??the range of exposure, and compare. Results: endoscopy and microscopy can see sphenoid opening carina of the internal carotid artery, the optic canal carina sellar pituitary, slopes structure. 0 ° endoscopic saddle and saddle exposed poor, 30 ° lens achieve ideal exposure, can clearly see the structure of the pituitary gland, the pituitary stalk, the internal carotid artery, the optic chiasm, pituitary on arterial saddle nodules. Microsurgical anatomy of the range of exposure to the saddle area transsphenoidal approach: the front to the straight back, side to the internal carotid artery cavernous segment, the end of the after Fangzhi Ji bottom artery; endoscopic anatomy exposed areas: the front to the optic chiasm side to the side wall of the cavernous sinus, after Fangzhi Ji bottom artery end. Sphenoid sinus opening, the sellar and slopes depression is the main anatomic landmarks of the approach. Conclusion: the transsphenoidal approach, endoscopy than microscopy displayed a wider range of surgical field the observed anatomical structure. Unique perspective in Neuroendoscopy, the approach can be fully exposed anatomical structure of the saddle area, but the surgeon must be familiar with the characteristics of the positioning points and endoscopic anatomy before to avoid the damage of the normal structure, to safely and effectively cut lesions. The second part of the purpose of the clinical application of endoscopy in the saddle area lesions: study of endoscopic assisted microsurgery neurosurgery practicality and its advantages for the treatment of pituitary adenomas. Methods: 32 cases of pituitary tumor location, size and growth direction, through pterional surgery in six cases approach, Endonasal - sphenoid surgery 26 cases. Postoperative follow-up review pituitary MRI hormones and visual perspective. Mean follow-up of 3.1 to 23.2 months. Results: 32 cases of sellar region lesions are pituitary adenomas confirmed by pathology. 30 cases without recurrence during the follow-up period, 2 patients relapsed, 1 case of recurrent giant pituitary adenoma, the other was a giant pituitary adenoma. Visual acuity vision improved in 19 cases, hormones decreased to normal in 20 cases, preoperative infertility by postoperative sterile two cases, with no deaths. Postoperative diabetes insipidus by one cases were cured after active treatment, 2 patients required hormone replacement therapy. Conclusion: The endoscopic-assisted microscope surgical treatment of pituitary adenomas is feasible, it can make the two complement each other, take full advantage of the natural clearance of the tumor is the fullest, most reasonable exposure, is conducive to tumor removal, reduce postoperative complications to improve the prognosis of patients.

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CLC: > Medicine, health > Oncology > Internal endocrine tumors > Pituitary tumor
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