目的探讨显微手术切除大型、巨大型垂体瘤视神经保护的操作技术及经验。方法对40例巨大垂体瘤患者采用翼点入路,显微镜下先行瘤内切除,待瘤内空虚再分离视神经。对14例巨大垂体瘤患者采用经鼻蝶入路,采用计算机辅助导航切开鞍底、进入鞍内,取瘤器切除瘤体减压。结果翼点入路全切除肿瘤22例,次全切除肿瘤18例,鼻蝶入路,全切除2例,次全切除6例,部分切除6例,视神经解剖全部保留。视力:翼点入路好转34例,无改善4例,恶化2例。鼻蝶入路好转12例,无改善2例。结论大型、巨大型垂体瘤不同手术入路的选择,利用视神经显微解剖的知识,及视神经保护的操作技术,可减少视神经损害,减少致残率。 Objective To investigate the operation technique and experience of microsurgical removal of optic nerve in large and huge pituitary tumors. Methods Forty cases of giant pituitary tumor were treated with pterional approach. The tumor was resected under the microscope, and the optic nerve was resected after the tumor was emptied. Fourteen patients with giant pituitary adenomas were treated with transnasal approach, and computer-aided navigation was used to incise the saddle and into the saddle to remove the tumor. Results Totally 22 tumors were excised by pterional approach, 18 were subtotal resected tumors, 2 were totally removed, 6 were subtotally removed, 6 were partially resected and the optic nerve was preserved. Visual acuity: pterional approach improved in 34 cases, 4 cases without improvement, 2 cases of deterioration. Improved nasal approach in 12 cases, no improvement in 2 cases. Conclusions The selection of different surgical approaches for large and huge pituitary tumors, the knowledge of microdissection of optic nerve and the operation technique of optic nerve protection can reduce optic nerve damage and reduce the morbidity.