Objective to investigate the feasibility and advantages of microsurgery of pituitary adenoma via endoscope - assisted direct transsphenoidal approach 摘要目的探讨经鼻内窥镜辅助下直接蝶窦入路显微外科垂体瘤切除术的可行性和优越性。
In all cases , the isolated space - occupying lesions in sphenoid sinus were verified by ct scan , and biopsies were made under nasal endoscopy before operation 恶性肿瘤4例，包括蝶窦低分化鳞癌2例，腺样囊性癌1例，内翻性乳头状瘤恶变1例。
Care must be taken not to penetrate nor instrument the sinus in its lateral portion , as trauma may be caused to the optic nerves situated superiorly , or to the internal corroded inferiorly 钳将开口扩大。必须注意不能穿透或者用器械探及蝶窦侧壁，以免损伤前方的视神经。
Results : three of them had their visual acuity improved from nlp , lp to 0 . 2 0 . 4 after the operation . the operative opportunity , merits of operative approaches , the key factors of treatment were discussed 结论：认为经鼻内窥镜筛蝶窦进路视神经管减压术，出血少，有更大的实用性，是治疗视神经损伤较好的手术方法。
Method : to analyse eleven cases with cerebrospinal fluid rhinorrhea , pituitary tumor , encephalomeningocele , sphenoid sinus cyst and ethmoid sinus tumor , were analyzed from 1998 to 2004 and beening followed up for 6 months to 6 years 方法：分析我科1998年~ 2004年间经鼻内镜手术治疗脑脊液鼻漏、垂体瘤、鼻内脑膜脑膨出、蝶窦囊肿、筛窦癌等，资料完整、随访时间为6个月~ 6年的病历11例。
Subtle changes , such as polyps in the early stages , can easily be identified . purulent secretions are seen streaming here from the maxillary sinus ostium posteriorally towards the nasopharynx . posteriorally , medial to the tail of the middle turbinate , the ostium of the sphenoid sinus may be identified 能很容易的发现类似早期息肉等微小的病变，还可以显示脓性分泌物从上颌窦口向后流向鼻咽部和后方的中鼻甲的后段和蝶窦的开口。
