Agrawal Amit, Cincu Rafael, Goel Atul
Division of Neurosurgery, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha-442005, Maharashtra, India.
Clin Neurol Neurosurg. 2007 Oct;109(8):645-50. doi: 10.1016/j.clineuro.2007.06.007. Epub 2007 Aug 7.
Despite their histologically benign nature, giant and 'invasive' pituitary tumors are one of the most complex neurosurgical challenges. In the present article, we discuss the current approaches to the management of giant pituitary tumors. Giant non-functioning pituitary tumors are usually confined inferiorly by the sellar dura, superiorly by the elevated diaphragma sellae, and laterally by an intact medial wall of the cavernous sinus. If the anatomical extensions of the tumor are understood and a radical tumor resection is achieved, the visual and long-term outcome can be extremely rewarding. The goals of surgery are to make a pathologic diagnosis and since the majority of these tumors are endocrinologically silent, the second goal should be to decompress the neural tissue. With the increasing experience and better understanding of anatomy of these tumors, trans-sphenoidal approaches have now replaced craniotomy for the excision of these tumors.
尽管巨大型和“侵袭性”垂体瘤在组织学上具有良性特征，但它们仍是神经外科面临的最复杂挑战之一。在本文中，我们讨论了目前治疗巨大型垂体瘤的方法。巨大型无功能垂体瘤通常下方受鞍底硬脑膜限制，上方受抬高的鞍膈限制，外侧受海绵窦完整的内侧壁限制。如果了解肿瘤的解剖学扩展情况并实现肿瘤的根治性切除，视觉和长期预后可能会非常理想。手术的目标是做出病理诊断，由于这些肿瘤大多数在内分泌方面无异常表现，第二个目标应该是减压神经组织。随着对这些肿瘤解剖结构的经验不断增加和理解不断加深，经蝶窦入路现已取代开颅手术用于切除这些肿瘤。
