The role of multimodal navigation in endoscopic endonasal surgery for giant pituitary adenomas.
The role of multimodal navigation in endoscopic endonasal surgery for giant pituitary adenomas.
复制标题
多模态导航在内窥镜鼻内手术中治疗巨大垂体腺瘤的作用。
DOI：
10.21037/gs.2019.11.06
复制
发表时间：
2019-12
期刊：
影响因子：
--
通讯作者：
Jia Dong
中科院分区：
文献类型：
--
作者：
Yang Chen;Zhang Jiarui;Li Jianzhong;Wu Nan;Jia Dong
背景
巨大垂体腺瘤（直径>40 mm）治疗难度大，根治性切除率低。术中多模式导航有时用于内窥镜鼻内手术（EES）。然而，该技术对GPA手术结局的影响尚不清楚。本研究旨在探索EES中导航用于GPA的手术和临床结局。
方法
对60例接受EES的GPA连续患者进行了回顾性分析。比较全切除率、残余量、临床结局和并发症。采用多项逻辑回归分析与肿瘤大体全切除（GTR）相关的因素。
结果
标准组31例未使用术中多模式导航，平均最大肿瘤直径为5.21±1.24 cm;导航组29例使用导航，平均最大肿瘤直径为5.32±1.18 cm。标准组有10例患者（32.26%）实现了GTR，显著低于导航组（18/29=62.07%）。标准组剩余体积为7.93±10.78 cm 3，明显大于导航组（2.44±1.26 cm 3，P=0.046）。两组在脑脊液（CSF）漏、新发垂体缺陷和术后尿崩症（DI）方面无显著差异。肿瘤的Knosp分级较高、分叶状结构和术中缺乏多模式导航使用是与GTR相关的相对风险因素。
结论
当在EES中用于GTR较高和残留肿瘤体积较低的GPA时，术中多模式导航似乎安全有效。
Background
Giant pituitary adenoma (GPA) (diameter >40 mm) remains challenging to treat, and the radical resection rate is low. The intraoperative multimodal navigation is sometimes used in endoscopic endonasal surgery (EES). However, the effect of this technique on GPA surgical outcomes is not clear. This study aims to explore the surgical and clinical outcomes of the navigation used in EES for GPA.
Methods
A retrospective review of 60 consecutive patients with GPA who underwent EES was performed. The total resection rate, residual volume, clinical outcomes, and complications were compared. Factors associated with tumor gross total resection (GTR) were analyzed by multinomial logistic regression analysis.
Results
There were 31 patients in the standard group in which intraoperative multimodal navigation was not used, with a mean maximum tumor diameter of 5.21±1.24 cm; meanwhile, there were 29 patients in the navigation group, in which navigation was used, with a mean maximum tumor diameter of 5.32±1.18 cm. GTR was achieved in 10 patients (32.26%) in the standard group, which was significantly lower than that in the navigation group (18/29=62.07%). The residual volume was 7.93±10.78 cm3 in the standard group which was significantly greater than that in the navigation group (2.44±1.26 cm3, P=0.046). There was no significant difference between the two groups in terms of cerebrospinal fluid (CSF) leak, new pituitary deficit, and postoperative diabetes insipidus (DI). The higher Knosp grade of tumor, lobulated configuration and lack of intraoperative multimodal navigation use were relative risk factors associated with the GTR.
Conclusions
The intraoperative multimode navigation appeared to be safe and effective when used in EES for GPA with higher GTR and lower residual tumor volume.
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DOI：
10.1007/978-3-7091-9183-5_12
发表时间：
1991
期刊：
Acta neurochirurgica. Supplementum
影响因子：
--
作者：
Engelbert Knosp;Klaus Kitz;E. Steiner;Ch. Matula
通讯作者：
Engelbert Knosp;Klaus Kitz;E. Steiner;Ch. Matula
影响因子：
1.1
作者：
A. Goel M Deogaonkar K Desai
通讯作者：
A. Goel M Deogaonkar K Desai
影响因子：
2.6
作者：
Hadad, Gustavo;Bassagasteguy, Luis;Mintz, Arlan
通讯作者：
Mintz, Arlan
影响因子：
4.1
作者：
Nishioka, Hiroshi;Fukuhara, Noriaki;Yamada, Shozo
通讯作者：
Yamada, Shozo
影响因子：
4.8
作者：
Dehdashti, Amir R.;Garma, Ahmed;Gentili, Fred
通讯作者：
Gentili, Fred