Sanai Nader, Quiñones-Hinojosa Alfredo, Narvid Jared, Kunwar Sandeep
Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, M-779, P.O. Box 0112, San Francisco, CA 94143, USA.
J Neurooncol. 2008 May;87(3):317-25. doi: 10.1007/s11060-007-9512-2. Epub 2007 Dec 19.
The direct endonasal approach to pituitary microadenomas is relatively atraumatic, rapid, and carries a lower complication rate than the sublabial approach. Large macroadenomas (3-4 cm) can still be addressed with this simple, unmodified direct endonasal approach. We present our experience with this unique and challenging patient population.
About 64 consecutive patients with large (3-4 cm) pituitary adenomas and craniopharyngiomas were treated by the senior author (SK) using the direct endonasal approach from May 2001 to July 2004. The hospital course, endocrinological function, radiographic imaging, and outpatient follow-up were retrospectively reviewed for each patient.
The mean volume of these lesions was 31.5 cm(3) (range, 10.3-168 cm(3)). Tumor pathologies included 2 craniopharyngiomas, 16 functional, and 46 nonfunctional pituitary adenomas. Suprasellar extension of tumor was evident in all patients and 10 had cavernous sinus invasion. Gross total resection was achieved in 30 patients, near-gross total in 6 patients, and subtotal resection in 26 patients. Eight patients (12.5%) demonstrated postoperative complications, with diabetes insipidus for less than 1 year (n = 4) being the most common. There was no incidence of CSF leak, new panhypopituitarism, or worsened vision. Five patients (7.8%) had tumor residual requiring radiation therapy. Additionally, after a mean clinical follow-up of 24.5 months, 4 patients (6.3%) demonstrated recurrent disease.
Direct endonasal transsphenoidal surgery enables safe and effective resection of large sellar masses while maintaining a favorable morbidity profile.
经鼻直接入路治疗垂体微腺瘤相对无创、快速，且并发症发生率低于经唇下入路。大型垂体大腺瘤（3 - 4厘米）仍可通过这种简单、未改良的经鼻直接入路进行治疗。我们介绍我们在这一独特且具有挑战性的患者群体中的经验。
从2001年5月至2004年7月，资深作者（SK）采用经鼻直接入路连续治疗了约64例大型（3 - 4厘米）垂体腺瘤和颅咽管瘤患者。对每位患者的住院病程、内分泌功能、影像学检查及门诊随访情况进行回顾性分析。
这些病变的平均体积为31.5立方厘米（范围为10.3 - 168立方厘米）。肿瘤病理包括2例颅咽管瘤、16例功能性垂体腺瘤和46例无功能性垂体腺瘤。所有患者均有肿瘤向鞍上扩展，10例有海绵窦侵犯。30例患者实现了全切，6例接近全切，26例为次全切。8例患者（12.5%）出现术后并发症，其中最常见的是尿崩症持续时间少于1年（n = 4）。未发生脑脊液漏、新发全垂体功能减退或视力恶化。5例患者（7.8%）有肿瘤残留需要放疗。此外，平均临床随访24.5个月后，4例患者（6.3%）出现疾病复发。
经鼻直接经蝶窦手术能够安全有效地切除大型鞍区肿物，同时保持良好的发病率情况。
