Long term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas.
Long term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas.
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DOI：
10.1007/s11102-010-0221-z
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发表时间：
2010-09
期刊：
影响因子：
3.8
通讯作者：
Kunwar, Sandeep
中科院分区：
文献类型：
--
作者：
Chang, Edward F.;Sughrue, Michael E.;Zada, Gabriel;Wilson, Charles B.;Blevins, Lewis S., Jr.;Kunwar, Sandeep
人们普遍认为，大多数内分泌非活动性垂体大腺瘤（EIA）的标准一线治疗是手术，通常通过经蝶入路。目前尚不清楚的是，当这些肿瘤复发时，特别是当这种复发涉及难以手术切除肿瘤的区域时，如鞍上区或海绵窦。我们对81例复发性非分泌性垂体腺瘤再次手术的患者进行了长期随访。我们分析了1970年1月至2001年3月间在加州大学旧金山分校弗朗西斯科接受第二次显微手术经蝶窦切除经组织学证实的内分泌不活跃垂体腺瘤的所有成年患者的资料。这些患者的数据是通过审查医疗记录、邮件和/或电话采访收集的。分析该系列的视觉功能、垂体前叶功能和肿瘤控制率。共有81例复发性EIA患者的记录可用。初次手术和再次手术之间的平均时间为4.1年。平均肿瘤大小为2.2 ± 0.2 cm。共有35/81例患者的随访时间超过5年。共有24/81例患者的随访时间超过10年。超过一半的患者出现视力障碍，我们发现其中39%的患者在第二次手术后视力得到改善。更重要的是，没有一个视力正常的人遭受任何明显的视力下降。在我们的系列中，大约35%的术前垂体前叶功能障碍患者在手术后恢复功能;没有患者的功能恶化。术后随访超过2年的52例患者中共有4例（8%）发生了具有临床意义的肿瘤复发，需要额外治疗。我们的数据表明，当由经验丰富的经蝶外科医生进行手术时，可以在这些经常局部侵袭性肿瘤中获得持久的肿瘤控制，术后发病率可接受。
It is widely accepted that the standard first-line treatment for most endocrine inactive pituitary macroadenomas (EIA) is surgery, usually via a transsphenoidal approach. What is less clear is what approach to take when these tumors recur, especially when this recurrence involves areas which are difficult to surgically remove tumor from, such as the suprasellar region or cavernous sinuses. We present long term follow-up for a series of 81 patients who underwent repeat surgery for recurrent non-secreting pituitary adenomas. We analyzed data collected from all adult patients undergoing their second microsurgical transsphenoidal resection of a histologically proven endocrine-inactive pituitary adenoma at the University of California at San Francisco between January 1970 and March 2001. Data for these patients were collected by review of medical records, mail, and/or telephone interviews. Visual function, anterior pituitary function, and tumor control rates were analyzed for the series. Records were available for a total of 81 recurrent EIA patients. The median time between their initial and repeat operations was 4.1 years. The mean tumor size was 2.2 ± 0.2 cm. A total of 35/81 patients had greater than 5 years of follow-up. A total of 24/81 patients had greater than 10 years of follow-up. Over one half of these patients presented with visual disturbance, and we found that 39% of these patients experienced improved vision with a second surgery. More importantly, no one with normal vision suffered any appreciable decline in vision. Approximately, 35% of patients with pre-operative anterior pituitary dysfunction recovered function after surgery in our series; and no patient’s function worsened. A total of 4/52 (8%) patients with greater than 2 years of post-op follow-up experienced a clinically meaningful tumor recurrence requiring additional treatment. Our data suggest that when performed by experienced transsphenoidal surgeons, durable tumor control can be obtained in these frequently locally aggressive tumors with acceptable rates of post-operative morbidity.
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