Feiz-Erfan Iman, Rao Ganesh, White William L, McCutcheon Ian E
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Skull Base. 2008 Mar;18(2):77-84. doi: 10.1055/s-2007-991105.
The rate of symptomatic improvement of visual symptoms associated with hematogenous metastases to the sella and pituitary was evaluated retrospectively in seven patients (five men, two women; mean age, 52.3 years) with primarily visual symptoms (diplopia alone in three, diplopia with blurred vision in one, blurred vision alone in one, loss of peripheral vision in one, and unilateral complete blindness in one). Symptom duration ranged from 0.5 to 2 months. The primary diseases were non-small cell lung cancer in two patients, renal cell carcinoma in two patients, prostate cancer in two patients, and medullary thyroid carcinoma in one patient. All patients had widespread metastatic disease. Three patients had a suprasellar tumoral component. One patient had a clival extension, and one patient had extension into the cavernous sinus. All underwent trans-sphenoidal surgery to correct visual symptoms. Gross total resection was achieved in three patients. Subtotal resections and a partial resection were performed in three patients and one patient, respectively. Surgical blood loss averaged 282 mL. One patient died from sepsis. Five patients developed complications (cerebrospinal fluid leakage in three, diabetes insipidus in two, anterior pituitary dysfunction in two, and colitis in one). At a mean follow-up of 15 months, three patients were alive. Visual symptoms improved in five patients and were unchanged in two. Trans-sphenoidal surgery helped improve visual symptoms in most patients. The morbidity rate was high and likely related to the locally destructive and extensive nature of the lesions in overall morbid patients with widespread metastatic disease. Unless nonoperative measures can provide equal results, however, this approach provides reasonable palliation.
回顾性评估了7例以视觉症状为主（3例单纯复视，1例复视伴视力模糊，1例单纯视力模糊，1例周边视野缺损，1例单侧完全失明）的患者（5例男性，2例女性；平均年龄52.3岁），这些患者因血行转移至鞍区和垂体而出现视觉症状。症状持续时间为0.5至2个月。原发疾病为2例非小细胞肺癌、2例肾细胞癌、2例前列腺癌和1例甲状腺髓样癌。所有患者均有广泛转移。3例患者有鞍上肿瘤成分。1例患者有斜坡延伸，1例患者延伸至海绵窦。所有患者均接受经蝶窦手术以改善视觉症状。3例患者实现了全切除。3例患者和1例患者分别进行了次全切除和部分切除。手术平均失血量为282 mL。1例患者死于败血症。5例患者出现并发症（3例脑脊液漏，2例尿崩症，2例垂体前叶功能障碍，1例结肠炎）。平均随访15个月时，3例患者存活。5例患者视觉症状改善，2例无变化。经蝶窦手术有助于大多数患者改善视觉症状。发病率较高，可能与广泛转移的整体患病患者中病变的局部破坏性和广泛性有关。然而，除非非手术措施能取得相同效果，否则这种方法可提供合理的姑息治疗。
