Surgical Results of Large and Giant Pituitary Adenomas with Special Consideration of Ophthalmologic Outcomes
Surgical Results of Large and Giant Pituitary Adenomas with Special Consideration of Ophthalmologic Outcomes
复制标题
DOI：
10.1016/j.wneu.2011.02.009
复制
发表时间：
2011-07-01
影响因子：
2
通讯作者：
Aydin, Yunus
中科院分区：
文献类型：
--
作者：
Musluman, Ahmet Murat;Cansever, Tufan;Aydin, Yunus
目的：分析大于 3 cm 的功能性和无功能性垂体腺瘤 (PA)，特别强调术前和术后视功能。方法：病例包括 49 名女性和 54 名男性，平均年龄 43.2 岁（范围 19-66 岁）。所有病例都有直径> 3 cm的大腺瘤。经蝶入路共 117 例，经颅入路 8 例。 103 名患者中有 50 名实现了肿瘤根治性切除。对 88 名患者进行了术后评估。评估术前和术后的视力、视野和眼底及其与症状模式、持续时间和肿瘤大小的关系。结果：71.5%的患者视力恢复正常，13.6%的患者出现改善，13.6%的患者症状持续，1%的患者症状恶化。 74.1% 的患者术后视野缺损 (VFD) 有所改善，92% 的患者术后视力障碍评分有所改善。视力丧失发生前 6 个月以内接受手术的患者视力改善更好、更持久。 1 名患者死亡，15.5% 的患者出现手术相关并发症。 结论：本研究表明，如果早期进行手术减压，视力严重障碍的患者可能会有显着改善。应进行经蝶入路以矫正患者的视力障碍并减轻任何大小的大腺瘤对视神经造成的压力。
OBJECTIVE: To analyze functioning and nonfunctioning pituitary adenomas (PAs) > 3 cm, with special emphasis on preoperative and postoperative visual functions.METHODS: The cases consisted of 49 women and 54 men with mean age of 43.2 years (range 19-66 years). All cases had a macroadenoma > 3 cm in diameter. The transsphenoidal approach was performed in 117 procedures, and the transcranial approach was performed in 8 procedures. Radical tumor excision was achieved in 50 of 103 patients. Postoperative evaluation was done in 88 patients. Preoperative and postoperative visual acuity, visual field, and ocular fundi and their relationship with the pattern and duration of the symptoms and the size of the tumor were evaluated.RESULTS: Normalization of visual acuity was obtained in 71.5% of patients, improvement occurred in 13.6%, symptoms persisted in 13.6%, and symptoms worsened in 1%. Postoperative improvement of visual field defects (VFDs) was observed in 74.1% of patients, and visual impairment score improved postoperatively in 92% of patients. Patients operated on < 6 months before the onset of vision loss had better and more sustained visual improvement. One patient died, and 15.5% of patients experienced surgery-related complications.CONCLUSIONS: This study shows that patients with severe visual impairment may have remarkable improvement if surgical decompression is done early. The transsphenoidal approach should be performed to correct the patient's visual impairment and to relieve the pressure on the optic apparatus caused by macroadenoma of any size.