下垂体腺腫に対する経蝶形骨洞法再手術

Repeated Transsphenoidal Surgery for Pituitary Adenomas

I．はじめに

　脳下垂体腺腫に対する経蝶形骨洞法の手術法についてはそのvariationを含め多くのすぐれた著述がなされているが^{3-5,7,9,12,13）}，その再手術に関する手術法の詳しい記載は少ない^10）．再手術は鼻粘膜などの損傷の可能性が高いことと，正常解剖の同定が難しいことなどに加えて，その有効性が低いなどと難しい点が多い^11）．経蝶形骨洞法再手術の経験のなかから，再手術時の問題点およびそれらの対策などについて検討したので報告する．

It is well known that the risks in patients subjected to repeated transsphenoidal surgery are higher than in patients without prior therapy. The authors report their experience of repeated transsphenoidal surgery in 18 pituitary adenoma cases, 7 as the second step of two staged operation, 7 for recurrent adenomas and 4 for the postoperative CSF rhinorrhea. Technical points in re-opening and closure of the transsphenoidal route are presented. A huge adenoma with suprasellar extensionmay be successfully removed by two staged operation. Some adenomas become less hemorrhagic at the second operation.