Utility and Safety of the Flexible-Fiber CO2 Laser in Endoscopic Endonasal Transsphenoidal Surgery
Utility and Safety of the Flexible-Fiber CO2 Laser in Endoscopic Endonasal Transsphenoidal Surgery
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DOI：
10.1016/j.wneu.2010.10.038
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发表时间：
2011-07-01
影响因子：
2
通讯作者：
Chin, Lawrence S.
中科院分区：
文献类型：
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作者：
Jayarao, Mayur;Devaiah, Anand K.;Chin, Lawrence S.
背景技术背景：本研究旨在报告的实用性和安全性的柔性纤维CO2激光内窥镜鼻内经蝶surgery.METHODS：一项回顾性的图表审查确定了16例接受激光辅助经蝶手术。考虑所有肿瘤病理学类型。结果进行了评估的基础上激素状态，肿瘤大小，病理，并发症，切除rate.Results：16垂体病变（垂体腺瘤，12; Rathke裂囊肿，2;垂体囊肿和颅咽管瘤，各1），平均大小为22.7毫米的影像学和病理标准。所有患者均接受了柔性纤维CO2激光辅助内镜下经鼻蝶窦手术。8例为非分泌性腺瘤，4例为分泌性腺瘤（3例为泌乳素腺瘤，1例为促肾上腺皮质激素腺瘤）。平均随访19.3个月后，16例患者中7例（43.75%）实现了大体全切除，所有患者（100%）激素缓解。3例患者（18.75%）发生术后并发症：2例患者发生一过性尿崩症（DI），1例发生需要手术修复的CSF漏。5例患者（31.25%）进行了术后放射残留lessons.CONCLUSIONS：我们发现，CO2激光辅助内镜下经鼻蝶鞍肿瘤手术是一种微创的方法，使用的工具，是快速和有效的切割和凝固。手术并发症发生率低，未发生激光相关并发症。激光光纤允许外科医生安全地切割和凝固，而不会遇到传统CO2激光器的视线问题。建议进一步研究，以进一步确定其在内镜下鼻内鞍区手术中的作用。
BACKGROUND: This study sought to report on the utility and safety of the flexible-fiber CO2 laser in endoscopic endonasal transsphenoidal surgery.METHODS: A retrospective chart review identified 16 patients who underwent laser-assisted transsphenoidal surgery. All tumor pathology types were considered. Results were assessed based on hormone status, tumor size, pathology, complications, and resection rates.RESULTS: Sixteen pituitary lesions (pituitary adenomas, 12; Rathke cleft cyst, 2; pituitary cyst and craniopharyngioma, 1 each) with an average size of 22.7 mm were identified by radiographic and pathologic criteria. All patients underwent flexible-fiber CO2 laser-assisted endoscopic endonasal transsphenoidal surgery. Of the adenomas, 8 were nonsecreting and 4 were secreting (3 prolactinomas and 1 ACTH secreting). Gross total resection was achieved in 7 of 16 patients (43.75%) with hormone remission in all patients (100%) after a mean follow-up of 19.3 months. Postoperative complications occurred in 3 patients (18.75%): 2 patients developed transient diabetes insipidus (DI) and 1 developed a CSF leak requiring surgical repair. Five patients (31.25%) underwent postoperative radiation to the residual lesions.CONCLUSIONS: We found that CO2-laser-assisted endoscopic endonasal transsphenoidal surgery for sellar tumors is a minimally invasive approach using a tool that is quick and effective at cutting and coagulation. The surgery has a low rate of complication, and no laser-related complications were encountered. The laser fiber allows the surgeon to safely cut and coagulate without the line-of-sight problems encountered with conventional CO2 lasers. Further studies are recommended to further define its role in endoscopic endonasal sellar surgery.