Transnasal Endoscopic Surgery For Sella Region Tumors And Imaging Anatomy Study On Sella Region

PartⅠTransnasal endoscopic surgery for sella region tumorsObjective:To explore the effect of a transnasal endoscopic approach for sella region tumors.Methods:Clinical data of 8 patients with sella region tumors from November 2004 to June 2008 were retrospectively analyzed.All of them received transnasal endoscopic surgeries.All the operations were performed under general anesthesia.There were 6 pituitary adenomas,1 chordoma,and 1 primitive neuroectodemal tumors.Follow-up period ranged from 3 months to 4 years.Results:Tumors were totally removed in 7 cases and was sub totally removed in 1. Cerebrospinal leakage appeared after the operations and was cured by two time operations in 1 case.There was no intracranial hemorrhage,intracranial infection and death in all patients.Conclusion:A transnasal endoscopic approach can expose and completely remove the sella region tumors in appropriate cases,and can identify the tissues in deep. Reconstruction of the skull base and dural treatment is not necessary in most cases. Operators must hold skillful anatomic intelligence,surgical technique and experiences as well as advanced surgical apparatuses.PartⅡ HRCT evaluation and guidance of the anatomical structure related to transnasal endoscopic approachObjective Reconstruct the image using multi-planar reformation(MPR) of high resolution computed tomography(HRCT),then measure the relevant line and related structures,to provide the imaging anatomy basis related to transnasal endoscopic approach for resection of lesions in the sella regionMethods 22 healthy adults were studied of normal HRCT after MPR respectively; there was no deformity,traumatic changes,skull base tumors and masses,and obvious inflammation lesions.All the images were transferred to a workstation for image post-processing.Observe and measure the following indicators:length of sphenoid sinus,the distance between extension Line of nasal septum and the lateral wall of the sphenoid sinus,related line of transnasal endoscopic approach,the relationship between Sphenoid sinus,ethmoid sinus and the optic canal and so on.Results Horizontal length of sphenoid sinus was 37.3±7.0(28.5～49.2)mm,vertical length was 26.4±4.8(15.4～32.2)mm,and the axial length was 25.9±6.0(14.5～34.9) mm.The distance between extension Line of nasal septum and the lateral wall of the sphenoid sinus was 18.8±3.4(14.3～26.3)mm and 17.4±3.3(12.7～22.1)mm.The relationship between the posterior ethmoid sinus,sphenoid sinus and optic canal were divided into three types,and sphenoid sinus dominant type accounted for the largest proportion.The distance between the sphenoidal crest and the optic canals were equal. So the sphenoidal crest was the key midline landmark in the approach.Conclusion The high resolution computed tomography(HRCT),using multi-planar reformation(MPR) show three dimensional image of the skull base,which is significant to the clinical application of transnasal endoscopic approach.PartⅢThe value of pro-Surgery MRI Apply for Pituitary AdenomaObjective To explore the value and characteristics of pro-surgery MRI for the choice of surgical approach to pituitary adenoma.Methods Thirty cases of pituitary adenoma proved by surgical pathology were examined by MRI.The tumor signal characteristic,extension and growth mode were analyzed.Results Among 30 cases,20 were macro-adenoma,and 10 were micro-adenoma, most of macro-adenoma showed moderately hypo intensity on T1WI and hyper intensity on T2WI,in micro-adenoma the signal were low,Adenoma showed various contrast in the post enhancement MRI.Contrast enhancement of MRI was capable of delineating size,location,extent of the tumor and the remaining intact pituitary tissue.Conclusion:MRI can show clearly the area of the involvement of the tumor and growth mode,have great value for the choice of surgical approach to pituitary adenoma.