Laws Edward R
Department of Neurosurgery, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
Rev Endocr Metab Disord. 2008 Mar;9(1):67-70. doi: 10.1007/s11154-007-9064-y.
This paper presents an overview of the evolution of pituitary surgery for acromegaly. It begins with the first case, attempted in 1893, through the initial transsphenoidal successes in 1907-1910, to the development of effective craniotomy approaches, and ultimately to the resurrection of the transsphenoidal approach in the 1970s and thereafter. Today, the minimally endoscopic transnasal endoscopic approach is fast becoming the norm. Indications for surgery include active acromegaly, visual loss and other forms of mass effect, pituitary tumor apoplexy, and failure of other therapies (medical, radiation). Contraindications include advanced age, debility or other medical conditions increasing the risk of general anaesthesia or surgery. Surgery for acromegaly has the advantage of immediate lowering of the growth hormone excess, with endocrine remission rates of 70% for microadenomas and 50% for macroadenomas. When surgery fails to obtain remission, a program of therapy is designed for the patient to include adjunctive medical therapy (dopamine agonists, somatostatin analogs, and growth hormone receptor antagonists), radiation therapy or radiosurgery (Gamma knife, Cyberknife, etc.).
本文概述了肢端肥大症垂体手术的发展历程。它始于1893年的首例尝试，历经1907 - 1910年经蝶窦手术的初步成功，到有效开颅手术方法的发展，最终到20世纪70年代及之后经蝶窦手术方法的复兴。如今，微创经鼻内镜手术方法正迅速成为标准术式。手术适应证包括活动性肢端肥大症、视力丧失及其他形式的占位效应、垂体瘤卒中以及其他治疗方法（药物、放疗）失败。禁忌证包括高龄、身体虚弱或其他增加全身麻醉或手术风险的内科疾病。肢端肥大症手术的优势在于能立即降低生长激素过量水平，微腺瘤的内分泌缓解率为70%，大腺瘤为50%。当手术未能实现缓解时，会为患者制定一个治疗方案，包括辅助药物治疗（多巴胺激动剂、生长抑素类似物和生长激素受体拮抗剂）、放射治疗或放射外科手术（伽玛刀、射波刀等）。
