摘要目的 探讨术中磁共振成像(iMRI)在内镜经鼻蝶手术切除复发性垂体腺瘤中的应用价值.方法 回顾性纳入2009年2月至2015年2月中国人民解放军总医院第一医学中心神经外科收治的29例复发性垂体腺瘤患者.所有患者均在iMRI辅助下采用手术切除肿瘤,分析肿瘤的切除程度、扫描次数及时间、手术并发症、症状和体征的改善情况以及随访结果.结果 24例患者术前根据Knosp分级预期肿瘤可全切除,16例通过iMRI进行术中第1次扫描提示肿瘤全切除,其余8例经扩大切除后,第2次扫描发现4例达到全切除,经过3次及以上扩大切除后,术中扫描提示另有2例患者达到肿瘤全切除,2例有肿瘤组织残留.术中扫描平均(1.6±0.8)次/例,扫描平均用时为(45.9±19.3)min,手术平均用时为(157.2±55.6) min.术后头痛的缓解比例为11/13,视力障碍的缓解比例为12/15.术后新发垂体功能低下2例,嗅觉障碍1例,一过性尿崩7例,脑脊液漏2例.术后29例患者随访3 ～ 67个月,平均(46.6±19.4)个月.行肿瘤全切除的22例患者中,有2例复发.结论 对于复发性垂体腺瘤,应用iMRI辅助内镜下手术的全切除率高、术后并发症少,是安全、有效的治疗方法.

abstractsObjective To investigate the clinical value of intraoperative magnetic resonance imaging (iMRI) in endoscopic transsphenoidal surgery for recurrent pituitary adenomas.Methods A retrospective analysis was conducted on 29 cases of surgically treated patients with recurrent pituitary adenomas at Neurosurgery Department of the First Medical Center of Chinese PLA Greneral Hospital from February 2009 to February 2015.All patients underwent surgical resection of tumor with intraoperative magnetic resonance imaging.The parameters evaluated included the extent of tumor resection,scanning frequency and timing,relief of symptoms and signs,follow-up results and complications.Results Among 24 patients with possible totally resection according to the Knosp grading,16 showed total tumor resection through the first intraoperative scanning and the second intraoperative scanning revealed another 4 cases achieving total resection after extended resection.After more than 3 times of extended resection,intraoperative scanning revealed 2 patients with total resection and the remaining 2 patients had residual tumor tissues.The number of intraoperative scanning was 1.6 ± 0.8 times per case and the average scanning duration was 45.9 ± 19.3 minutes.The total time for surgery was 157.2 ± 55.6 minutes.The postoperative headache remission ratio was 11/13 and the visual dysfunction remission ratio was 12/15.Postoperative pituitary insufficiency occurred in 2 cases,olfactory disorder in 1 case,temporary diabetes insipidation in 7 cases and cerebrospinal fluid leakage in 2 cases.Twenty-nine patients were followed up for 3 to 67 months,with an average of 46.6 ± 19.4 months.There were 2 patients with tumor recurrence among the 22 patients with total tumor resection.Conclusion For recurrent pituitary adenomas,iMRI-assisted endoscopic resection seems to be a safe and effective treatment which has high rate of total resection and less postoperative complications.