Nonfunctioning pituitary adenomas in elderly patients
Nonfunctioning pituitary adenomas in elderly patients
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DOI：
10.1016/j.jocn.2018.04.054
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发表时间：
2018-07-01
影响因子：
2
通讯作者：
Arita, Kazunori
中科院分区：
文献类型：
--
作者：
Kinoshita, Yasuyuki;Kurisu, Kaoru;Arita, Kazunori
背景：最近，一些报道揭示了经蝶手术（TSS）治疗老年患者垂体病变的新方面。目的：本研究的目的是提供一个最新的文献综述，我们希望这将有助于管理无功能垂体腺瘤（NFPA）在老年patients.Methods：我们检索PubMed和Web of Science的报告TSS为NFPA在老年患者和审查的文献。结果：NFPA是老年人垂体腺瘤中最常见的形式，可引起肿瘤质量效应的症状。老年患者的肿瘤切除率和术后视力改善率与年轻患者相似;然而，老年患者从术前垂体功能减退症中恢复的难度更大。TSS与老年患者的低发病率和死亡率相关。然而，发病率和死亡率的风险有可能随着年龄的增长而增加。TSS不适用于仅表现出垂体功能减退症的老年患者，但也不适用于已经或预计会出现肿瘤质量效应的老年患者。前瞻性MRI随访无手术也可以提出了一个高的美国麻醉医师协会（阿萨）等级的老年患者或那些在其中没有证据表明肿瘤生长向opticpath.Conclusions：TSS被认为是一个安全的程序治疗NFPA，甚至是耐受的老年患者;但手术指征应严格，应根据病人的临床情况和放射学检查结果而定。(C)2018爱思唯尔有限公司版权所有
Background: Recently, several reports have revealed new aspects regarding transsphenoidal surgery (TSS) for pituitary lesions in elderly patients. Objective: The aim of present study is to provide an updated review of the recent literature, which we hope will contribute to the management of nonfunctioning pituitary adenoma (NFPA) in elderly patients.Methods: We searched PubMed and Web of Science for reports on TSS for NFPAs in elderly patients and reviewed the literature.Results: NFPAs, which cause the symptoms of tumor mass effect, are the most common form of pituitary adenoma in elderly individuals. The rates of tumor resection and postoperative visual improvement in elderly patients are similar to those in younger patients; however, elderly patients have greater difficulty in recovering from preoperative hypopituitarism. TSS is associated with low rates of morbidity and mortality in elderly patients. However, there is a possibility that the risks of morbidity and mortality increase with advancing age. TSS is not considered for elderly patients who show hypopituitarism alone, but who either have or are predicted to experience a tumor mass effect. Prospective MRI follow-up without surgery can be also proposed for elderly patients with a high American Society of Anesthesiologists (ASA) grade or those in whom there is no evidence of tumor growth towards the optic pathway.Conclusions: TSS is considered a safe procedure for the treatment of NFPA and is even tolerated by elderly patients; however, the surgical indications, which are based on the patient's clinical condition and the results of radiological examinations, should be strict. (C) 2018 Elsevier Ltd. All rights reserved.