Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas
Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas
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DOI：
10.3171/2011.1.focus10317
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发表时间：
2011-04-01
影响因子：
4.1
通讯作者：
Schwartz, Theodore H.
中科院分区：
文献类型：
--
作者：
Hofstetter, Christoph P.;Shin, Benjamin J.;Schwartz, Theodore H.
Object.本研究的目的是分析经鼻内窥镜切除治疗耐药的催乳素、生长激素（GH）和促肾上腺皮质激素（ACTH）分泌型垂体腺瘤后内分泌缓解的术前预测因素，并通过使用最新的共识标准建立治愈基准。方法。作者回顾了86例连续功能性垂体腺瘤的前瞻性数据库，这些腺瘤均采用单纯内镜下经鼻蝶技术切除。术后对比增强MR成像评价切除程度。根据最新的共识标准定义内分泌缓解。大多数功能性腺瘤（62.8%）被归类为大腺瘤（最大直径> 1 cm），20.9%的病变在手术时已侵入海绵窦（CS）。75.6%的患者实现了大体全切除。不同类型的功能性腺瘤的内分泌缓解率不同。催乳素瘤的治愈率分别为92.3%（微腺瘤）和57.1%（大腺瘤），GH分泌性肿瘤的治愈率分别为75%（微腺瘤）和40%（大腺瘤），ACTH分泌性肿瘤的治愈率分别为54.5%（微腺瘤）和71.4%（大腺瘤）。GH分泌性大腺瘤的治愈率较低，这是由于高比例的CS浸润，而ACTH分泌性腺瘤的治愈率较低，这是由于术前MR成像上看不到的病变比例较高。而单因素分析显示，大腺瘤，鞍上，海绵状扩展，或切除程度与治愈相关，多因素分析，只有切除程度和鞍上扩展预测治愈。1例患者术后发生脑膜炎，并发脑积水，需要脑室腹腔分流术。2例患者术后出现全垂体功能减退，2例患者出现脑脊液漏，均行腰椎脑脊液分流术治疗。本文报告了内分泌治疗的基准，以及在一个大系列的纯内窥镜垂体手术的并发症，使用最新的共识标准。扩大经鼻入路的优势在鞍上肿瘤和CS侵犯中最为明显。(DOI：10.3171/2011.1.FOC10317）
Object. The purpose of this study was to analyze preoperative predictors of endocrinological remission following endonasal endoscopic resection of therapy-resistant prolactin-, growth hormone (GH)-, and adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas and to establish benchmarks for cure by using the most recent consensus criteria.Methods. The authors reviewed a prospective database of 86 consecutive functional pituitary adenomas that were resected by a purely endoscopic endonasal transsphenoidal technique. Extent of resection was evaluated on postoperative contrast-enhanced MR imaging. Endocrinological remission was defined according to the most recent consensus criteria.Results. The majority of functional adenomas (62.8%) were classified as macroadenomas (> 1 cm in maximum diameter), and 20.9% of lesions had invaded the cavernous sinus (CS) at the time of surgery. A gross-total resection was achieved in 75.6% of all patients. The rate of endocrinological remission differed between various types of functional adenomas. Cure rates were 92.3% (microadenomas) and 57.1% (macroadenomas) for prolactinomas, 75% (microadenomas) and 40% (macroadenomas) for GH-secreting tumors, and 54.5% (microadenomas) and 71.4% (macroadenomas) for ACTH-secreting tumors. Lower rates of cure occurred in GH-secreting macroadenomas due to a high rate of CS invasion, and in ACTH-secreting adenomas due to a high rate of lesions that were not visible on preoperative MR imaging. Whereas univariate analysis showed that macroadenoma, suprasellar, cavernous extension, or extent of resection correlated with cure, on multivariate analysis, only extent of resection and suprasellar extension predicted cure. One patient developed postoperative meningitis that was complicated by hydrocephalus requiring a ventriculoperitoneal shunt. Two patients developed postoperative panhypopituitarism, and 2 patients suffered from CSF leaks, which were treated with lumbar CSF diversion.Conclusions. This paper reports benchmarks for endocrinological cure as well as complications in a large series of purely endoscopic pituitary surgeries by using the most recent consensus criteria. The advantages of extended endonasal approaches are most profound in tumors with suprasellar extension and CS invasion. (DOI: 10.3171/2011.1.FOCUS10317)