Value of preoperative magnetic resonance imaging in the protection of pituitary function in transsphenoidal pituitary adenoma
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摘要: 目的 探讨术前磁共振成像相关定位数据测量和瘤体质地评估在经鼻蝶垂体瘤切除术中的指导应用及对垂体功能的保护作用。 方法 回顾性分析中国科学技术大学第一附属医院2017年1月—2019年9月行经鼻蝶垂体瘤切除术的80例垂体瘤患者临床资料,术前、术后均进行MRI影像检查和垂体激素水平检测,对术前MRI矢状位和冠状位图像数据进行定位测量和垂体瘤质地评估。 结果 80例患者中有65例垂体大腺瘤和15例垂体小腺瘤,矢状位上鼻小柱至鞍底前壁中点距离为(71.32±2.04) mm;上述测量线与鼻底平面之间的夹角为(31.24±5.8)°;冠状位上颈内动脉海绵窦段间距为(20.74±0.48) mm;质地软的肿瘤呈高信号为主,质中和质硬的肿瘤呈低信号为主,增强扫描后瘤体明显强化。将所测量的数值应用于术中,所有患者均顺利抵达鞍底切除肿物,术后复查MRI提示肿瘤全切63例,次全切13例,部分切除4例。 结论 术前应用磁共振成像进行定位数据测量和瘤体质地评估有助于指导术者经鼻蝶顺利充分切除肿瘤,避免正常垂体组织损伤,利于彻底切除肿瘤,从而使患者激素恢复正常水平,为今后临床应用提供了一定的帮助。Abstract: Objective To explore the clinical value of preoperative magnetic resonance imaging data measurement and tumor constitution evaluation for guiding application and protection of pituitary function in transsphenoidal pituitary adenoma resection. Methods The clinical data of 80 patients with pituitary tumor who underwent transsphenoidal pituitary adenoma resection from January 2017 to September 2019 in the First Affiliated Hospital of USTC were retrospectively analyzed. MRI imaging and pituitary hormone levels were detected before and after surgery. Results In 80 patients, the distance between the nasal columella and the midpoint of the anterior sellar floor was (71.32±2.04) mm in the sagittal position, the angle between the above measurement line and the nasal floor plane was (31.24±5.8)°, and the distance between the cavernous sinus segment of the superior internal carotid artery was (20.74±0.48) mm in the coronal position. Soft texture showed high signal intensity, while neutral texture showed low signal intensity, which was obviously enhanced after enhanced scanning. Applying the measured values to the operation, all patients successfully reached the sellar floor to remove the mass. Postoperative MRI revealed total resection in 63 cases, subtotal resection in 13 cases and partial resection in 4 cases. Conclusion The application of MRI before transsphenoidal pituitary adenoma resection can help to accurately locate, safely and maximize open sellar floor bone, and clarify texture and size of pituitary tumors. It helps the surgeon to completely remove the tumor and reduce the damage to the normal pituitary function, so that the patients' hormone can return to normal levels. This would be helpful for the future clinical application.
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Key words:
- Magnetic resonance imaging /
- Pituitary adenoma /
- Transsphenoidal approach /
- Sellar floor /
- Tumor texture
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