Outcomes and Complications of Aggressive Resection Strategy for Pituitary Adenomas in Knosp Grade 4 With Transsphenoidal Endoscopy.
Outcomes and Complications of Aggressive Resection Strategy for Pituitary Adenomas in Knosp Grade 4 With Transsphenoidal Endoscopy.
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经蝶内镜检查 Knosp 4 级垂体腺瘤积极切除策略的结果和并发症
DOI：
10.3389/fonc.2021.693063
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发表时间：
2021
影响因子：
4.7
通讯作者：
Hong T
中科院分区：
文献类型：
--
作者：
Ouyang T;Zhang N;Xie S;Tang B;Li J;Xiao L;Zhang F;Wu B;Zhou D;Li M;Hong T
Knosp分级4级侵袭海绵窦的垂体腺瘤的手术治疗是一个巨大的挑战，是采取保守还是积极的手术策略存在争议。本研究的目的是提供Knosp 4级PA经蝶内镜手术的积极切除策略的结局和并发症。回顾性分析了102例Knosp 4级PA患者的结局和并发症。原发性肺动脉瘤60例，复发性肺动脉瘤42例。肿瘤全切72例（70.6%），次全切18例（17.6%），部分切除12例（11.8%）。此外，82例患者（80.4%）实现了CS内肿瘤的GTR，17例患者（16.7%）实现了STR，3例患者（2.9%）实现了PTR。经统计学分析，肿瘤复发和质地坚硬均是影响手术完全切除的不利因素（P<0.05）。肿瘤全切组的内分泌和视力预后较不全切组好（P<0.05）。总体而言，最常见的手术并发症是新发颅神经麻痹（n=7，6.8%）。颈内动脉（伊卡）损伤和术后脑脊液（CSF）漏的发生率分别为2.0%（n=2）和5.9%（n=6）。6例患者（5.9%）术后出现肿瘤复发。对于经验丰富的神经内镜医生，通过经蝶窦内镜手术进行积极的肿瘤切除策略可能是Knosp 4级PA的有效和安全的选择。
Surgery for pituitary adenomas (PAs) with cavernous sinus (CS) invasion in Knosp grade 4 is a great challenge and whether to adopt a conservative or aggressive surgical strategy is controversial. The aim of this study is to provide the outcomes and complications of an aggressive resection strategy for Knosp grade 4 PAs with transsphenoidal endoscopic surgery. Outcomes and complications were retrospectively analyzed in 102 patients with Knosp grade 4 PAs. Among them, primary PAs were seen in 60 patients and recurrent PAs were seen in 42 cases. Gross total resection (GTR) of the entire tumor was achieved in 72 cases (70.6%), subtotal tumor resection (STR) in 18 cases (17.6%), and partial tumor resection (PTR) in 12 cases (11.8%). Additionally, GTR of the tumor within the CS was achieved in 82 patients (80.4%), STR in 17 patients (16.7%), and PTR in 3 patients (2.9%). Statistical analyses showed that both recurrent tumors and firm consistency tumors were adverse factors for complete resection (P<0.05). Patients with GTR of the entire tumor were more likely to have favorable endocrine and visual outcomes than those with incomplete resection (P<0.05). Overall, the most common surgical complication was new cranial nerve palsy (n=7, 6.8%). The incidence of internal carotid artery (ICA) injury and postoperative cerebrospinal fluid (CSF) leakage was 2.0% (n=2) and 5.9% (n=6), respectively. Six patients (5.9%) experienced tumor recurrence postoperatively. For experienced neuroendoscopists, an aggressive tumor resection strategy via transsphenoidal endoscopic surgery may be an effective and safe option for Knosp grade 4 PAs.
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影响因子：
19.7
作者：
Cottier, JP;Destrieux, C;Herbreteau, D
通讯作者：
Herbreteau, D
影响因子：
3.8
作者：
Chang, Edward F.;Sughrue, Michael E.;Zada, Gabriel;Wilson, Charles B.;Blevins, Lewis S., Jr.;Kunwar, Sandeep
通讯作者：
Kunwar, Sandeep
影响因子：
4.1
作者：
Hofstetter, Christoph P.;Shin, Benjamin J.;Schwartz, Theodore H.
通讯作者：
Schwartz, Theodore H.
影响因子：
4.1
作者：
Fernandez-Miranda, Juan C.;Zwagerman, Nathan T.;Gardner, Paul A.
通讯作者：
Gardner, Paul A.
影响因子：
4.8
作者：
Dehdashti, Amir R.;Garma, Ahmed;Gentili, Fred
通讯作者：
Gentili, Fred