Salame K, Ouaknine G E, Yossipov J, Rochkind S
Department of Neurosurgery, Tel Aviv Sourasky Medical Center the Sackler Faculty of Medicine, Tel Aviv University, Israel.
J Neurooncol. 2001 Aug;54(1):49-52. doi: 10.1023/a:1012535230135.
Paraganglioma of the sellar area is extremely rare with only six cases having been reported in the literature. Surgical removal of these tumors is difficult, and the transsphenoidal approach usually results in limited resection. Most authors who published reports on this tumor recommended radiation therapy after partial removal of the tumor. However, considering the benign nature of these tumors, the risk of radiation-induced endocrine insufficiency and optic neuropathy and the lack of proven effectiveness of radiotherapy, its value remains controversial. We describe a 48-year-old woman with parasellar paraganglioma who presented with headaches, visual loss and oligomenorrhea. Magnetic resonance imaging (MRI) showed an invasive tumor in the sellar and parasellar areas which extended to both cavernous sinuses and compressed the optic chiasm and the left internal carotid artery. Surgery by the transsphenoidal approach enabled only limited biopsy of the tumor. The patient was reoperated by an extended pterional approach which resulted in a subtotal removal of the tumor and adequate decompression of the adjacent structures. She received no adjuvant treatment during the 8-year postsurgical follow-up and remained in good health. A repeated MRI showed no change in the size of the residual tumor. Contrary to the therapeutic recommendations described in previous reports, we favor postoperative adjuvant therapy only if the symptoms or signs of cranial nerve compression persist following maximal tumor removal, or if there is evidence of subsequent growth of residual tumor.
鞍区副神经节瘤极为罕见，文献中仅报道过6例。手术切除这些肿瘤难度较大，经蝶窦入路通常只能实现有限切除。大多数发表过关于该肿瘤报告的作者建议在肿瘤部分切除后进行放射治疗。然而，鉴于这些肿瘤的良性性质、放射诱导的内分泌功能不全和视神经病变风险以及放疗的有效性未经证实，其价值仍存在争议。我们描述了一名48岁患有鞍区副神经节瘤的女性，她出现头痛、视力丧失和月经过少症状。磁共振成像（MRI）显示鞍区和鞍旁区域有一个侵袭性肿瘤，该肿瘤延伸至双侧海绵窦，压迫视交叉和左颈内动脉。经蝶窦入路手术仅能对肿瘤进行有限的活检。患者通过扩大翼点入路再次手术，实现了肿瘤次全切除及对相邻结构的充分减压。在术后8年的随访中，她未接受辅助治疗，健康状况良好。复查MRI显示残留肿瘤大小无变化。与既往报告中描述的治疗建议相反，我们认为仅在肿瘤最大程度切除后仍存在颅神经受压症状或体征，或有证据表明残留肿瘤随后生长时，才应进行术后辅助治疗。
