目的探讨前纵裂入路显微切除巨大侵袭性垂体腺瘤的适应证和治疗效果。方法回顾性分析23例经前纵裂入路手术的巨大侵袭性垂体腺瘤患者的临床资料,其中复发侵袭性垂体腺瘤1例,术前影像检查示肿瘤向鞍内、三脑室底部、单或双侧海绵窦生长,多呈分叶状,9例伴有梗阻性脑积水。结果本组23例巨大侵袭性垂体腺瘤,术中肿瘤暴露良好,肿瘤全切16例(69.6%),大部切除7例;其中肿瘤与颈内动脉、海绵窦粘连紧密4例;垂体柄解剖保留17例。本组无死亡病例,无脑脊液漏病例;术后视力恢复或好转20例;术后多饮多尿8例,其中一过性尿崩5例,药物能控制的3例;电解质紊乱10例。19例术后随访6～24个月,行头颅磁共振扫描未见肿瘤复发。结论经前纵裂入路可以更大视角暴露中线结构,对脑组织损伤小,是切除向鞍上、三脑室底部生长的巨大侵袭性垂体腺瘤安全有效的手术入路。 Objective To investigate the indications and therapeutic effects of microsurgical removal of giant invasive pituitary adenomas by anterior longitudinal splitting approach. Methods The clinical data of 23 patients with giant invasive pituitary adenoma treated by anterior longitudinal approach were retrospectively analyzed. One patient had recurrent invasive pituitary adenoma. The preoperative imaging showed that the tumor was located in the saddle, the base of the third ventricle, Or bilateral cavernous sinus growth, mostly lobulated, 9 cases with obstructive hydrocephalus. Results Twenty-three cases of giant pituitary adenoma were found in this group. The tumors were well exposed during operation. Tumor resection was performed in 16 cases (69.6%) and in 7 cases in most resection. The tumor adhered closely to the internal carotid artery and cavernous sinus in 4 cases. The pituitary stalk Anatomy retained 17 cases. No deaths in this group, no cases of cerebrospinal fluid leakage; postoperative visual acuity recovery or improvement in 20 cases; postoperative polyhydramnios in 8 cases, including transient urinary atrophy in 5 cases, drug can be controlled in 3 cases; electrolyte imbalance in 10 cases. Twenty-nine patients were followed up for 6-24 months. Tumor recurrence was not observed in head magnetic resonance imaging. Conclusions The anterior longitudinal splitting approach can expose the midline structure with a larger visual angle and less damage to the brain tissue. It is a safe and effective surgical approach for resecting the huge invasive pituitary adenoma growing to the base of the suprasellar and tertiary ventricles.