Clinical Features of Pituitary or Parasellar Tumor Onset with Cranial Nerve Palsy: Surgical Intervention Considerations
Clinical Features of Pituitary or Parasellar Tumor Onset with Cranial Nerve Palsy: Surgical Intervention Considerations
复制标题
垂体或鞍旁肿瘤发病伴脑神经麻痹的临床特征：手术干预注意事项
DOI：
10.1016/j.wneu.2023.04.031
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发表时间：
2023
影响因子：
2
通讯作者：
Kawamata Takakazu
中科院分区：
文献类型：
--
作者：
Oda Yuichi;Amano Kosaku;Masui Kenta;Kawamata Takakazu
目的探讨脑神经麻痹（CNP）并发垂体或鞍旁肿瘤的症状，提高对这一罕见症状的认识和治疗方法。方法回顾性分析2003 ~ 2020年1281例经手术治疗的垂体或鞍旁肿瘤患者，其中30例（2.34%，男15例，女15例，平均年龄：55.6岁，范围：6 ~ 83岁）首次出现CNP的患者的神经系统症状、组织学诊断、发病至手术间隔、CNP完全恢复时间。结果病理诊断垂体腺瘤17例，其中垂体卒中10例，促肾上腺皮质激素阳性腺瘤4例；其他肿瘤13例，包括脊索瘤3例、黄色肉芽肿2例、恶性淋巴瘤2例、转移瘤2例、Rathke裂隙囊肿1例、浆细胞瘤1例、颅咽管瘤1例、神经内分泌癌1例。引起CNP的机制为脑垂体卒中（n = 10）、脑神经受压或受累（n = 17）和炎症改变（n = 9）。首发表现为动眼神经麻痹20例（66.7%），滑车神经麻痹2例（6.7%），外展神经麻痹13例（43.3%）。单纯手术后25例（83.3%）患者CNP完全恢复，辅助治疗后2例（6.7%）患者CNP完全恢复。早期手术虽然缩短了达到完全恢复的时间，但在完全恢复率方面没有显著差异。结论明确CNP的发病机制，进行手术干预，改善症状，缩短病程，防止复发，获得正确的病理诊断，选择合适的辅助治疗方案至关重要。
ObjectiveThis study aimed to clarify the symptoms of pituitary or parasellar tumor onset with cranial nerve palsy (CNP) and to improve our knowledge of this rare symptom and its most appropriate treatment.MethodsAmong 1281 patients with pituitary or parasellar tumors surgically treated from 2003 to 2020, 30 cases (2.34%; 15 men and 15 women; mean age: 55.6 years, range: 6–83 years) first presenting with CNP were reviewed to evaluate the neurological symptoms, histological diagnosis, interval from onset to surgery, and time before complete CNP recovery.ResultsPathological diagnoses comprised 17 pituitary adenomas, including 10 pituitary apoplexies and 4 adrenocorticotropic hormone-positive adenomas, and 13 other tumors, including 3 chordomas, 2 xanthogranulomas, 2 malignant lymphomas, 2 metastatic tumors, 1 Rathke cleft cyst, 1 plasmacytoma, 1 craniopharyngioma, and 1 neuroendocrine carcinoma. The mechanisms causing CNP were pituitary apoplexy (n = 10), cranial nerve compression or involvement (n = 17), and inflammatory changes (n = 9). As the first manifestation, 20 (66.7%) patients presented with oculomotor nerve palsy, 2 (6.7%) with trochlear nerve palsy, and 13 (43.3%) with abducens nerve palsy. Full recovery of CNP was obtained in 25 patients (83.3%) after surgery alone and in 2 patients (6.7%) after adjuvant therapy. Early surgery provided no significant difference in full recovery rates although it reduced the time to reach full recovery.ConclusionsIt is critical to determine the mechanisms of CNP and intervene surgically to improve symptoms, shorten the duration of the disorder, prevent relapses, and obtain the correct pathological diagnosis to select the proper adjuvant therapy.