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目的探讨垂体微腺瘤与视交叉功能障碍引起的颞侧视野缺损之间的关系,提出了经蝶手术治疗的意义。方法分析了北京协和医院经蝶手术治疗的5例术前有典型颞侧视野缺损的垂体微腺瘤,并结合文献加以讨论。结果这5例患者术前均有典型的颞侧视野缺损,经蝶手术治疗后3例患者的视野缺损恢复正常,2例不同程度改善。结论结合人体视交叉血液供应的解剖学研究,认为高灌注状态的垂体增殖性病变如肿瘤,通过它与视交叉的共同供应血管分枝进行“盗血”,或干扰了视交叉的正常血液供应,使视交叉中部存在的微循环薄弱环节发生供血障碍,而导致未对视交叉形成直接压迫的垂体微腺瘤能够引起颞侧视野缺损。经蝶手术治疗后5例患者的视野缺损均不同程度地改善或恢复正常,这既反证了上述机制的存在,又显示了经蝶手术治疗的积极意义。
Objective To explore the relationship between pituitary microadenomas and temporal visual field defects caused by optic chiasm dysfunction and put forward the significance of transsphenoidal surgery. Methods Five cases of pituitary microadenomas with typical temporal visual field defects before surgery undergoing transsphenoidal surgery in Peking Union Medical College Hospital were analyzed and discussed in the literature. Results All 5 patients had typical temporal visual field defects before surgery. The visual field defects of 3 patients returned to normal after operation of transsphenoidal surgery, and 2 cases improved to some extent. Conclusions Combined with anatomical studies of the blood supply to the human optic chiasm, it is hypothesized that hyperproliferative pituitary proliferative lesions, such as tumors, “steal blood” through its co-supply of vascular branches with the optic chiasm, or interfere with the normal blood supply to the optic chiasm , So that the central part of the optic chiasm microcirculation weakness occurs blood supply disorders, resulting in no direct oppression of the optic chiasm pituitary microadenomas can cause temporal visual field defects. The transthoracic surgery in 5 patients with visual field defects were improved or restored to varying degrees, which not only evidence of the existence of the above mechanism, but also shows the positive significance of transsphenoidal surgery.