Aggressive transsphenoidal resection of tumors invading the cavernous sinus in patients with acromegaly: predictive factors, strategies, and outcomes.
Aggressive transsphenoidal resection of tumors invading the cavernous sinus in patients with acromegaly: predictive factors, strategies, and outcomes.
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DOI：
10.3171/2014.3.jns132214
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发表时间：
2014-09-01
影响因子：
4.1
通讯作者：
Yamada, Shozo
中科院分区：
文献类型：
--
作者：
Nishioka, Hiroshi;Fukuhara, Noriaki;Yamada, Shozo
目的：海绵窦（CS）侵犯是生长型垂体腺瘤手术治疗中最重要的术前缓解预测因素。本研究的目的是评估的有效性，积极的技术切除肿瘤侵入CS在肢端肥大症patients with the measurements.METHODS：作者回顾性分析了150例肢端肥大症患者谁接受了主要经蝶手术在2010年和2011年的情况。作者回顾了术前Knosp分级、术中所见、CS内侧壁的组织学以及根据目前对肢端肥大症的共识标准的手术结果。（36.7%）：在41例患者中，在直视下观察到肿瘤明确累及CS 39例（70.9%）经组织学证实有浸润。随着Knosp分级的升高，侵袭频率增加，但在14.4%（13/90）的0级和1级肿瘤中观察到侵袭。总体而言，符合严格标准的缓解率为84.7%（127/150）。尽管CS侵袭与不良结局显著相关（p < 0.0001），但69.1%（38/55）的侵袭患者获得缓解。结论：海绵窦侵犯是最重要的，独立的预测不利的结果。无论使用何种显微镜或内窥镜，均需直接观察冠状窦内浸润。特别是在仅累及内侧壁的病例中，组织学检查对于发现隐匿性侵犯总是必要的。通过尖锐切除CS内侧壁直接切除侵犯的肿瘤是有效和安全的，并增加缓解的机会。
OBJECT: Cavernous sinus (CS) invasion is the most important preoperative predictor of remission in the surgical treatment of growth hormone-producing pituitary adenomas. The purpose of this study was to evaluate the effectiveness of an aggressive technique for removal of tumors invading the CS in patients with acromegaly.METHODS: The authors retrospectively reviewed the cases of 150 consecutive patients with acromegaly who underwent primary transsphenoidal surgery in 2010 and 2011. The authors reviewed preoperative Knosp grade, intraoperative findings, histology of the medial wall of the CS, and surgical outcome according to the current consensus criteria for acromegaly.RESULTS: Cavernous sinus invasion was identified in 55 patients (36.7%): definite CS involvement by the tumor was observed under direct vision in 41 patients (74.5%), while invasion was histologically verified in 39 patients (70.9%). Invasion increased in frequency with the higher Knosp grade but was observed in 14.4% (13 of 90) of Grade 0 and 1 tumors. Overall, the remission rate fulfilling stringent criteria was 84.7% (127 of 150). Although CS invasion was significantly associated with an unfavorable outcome (p < 0.0001), remission was achieved in 69.1% (38 of 55) of patients with invasion. No major complications occurred in this series.CONCLUSIONS: Cavernous sinus invasion is the most significant, independent predictor of unfavorable outcome. Confirmation of invasion requires direct observation within the CS regardless of the microscope or endoscope used. Particularly in cases in which only the medial wall is involved, histological verification is always necessary to detect the occult invasion. Direct removal of the invading tumor, by sharp excision of the medial wall of the CS, is effective and safe and increases the chance of remission.