Department of Neurological Surgery, University of California at San Francisco, San Francisco, CA, USA.
Pituitary. 2010 Sep;13(3):223-9. doi: 10.1007/s11102-010-0221-z.
It is widely accepted that the standard first-line treatment for most endocrine inactive pituitary macroadenomas (EIA) is surgery, usually via a transsphenoidal approach. What is less clear is what approach to take when these tumors recur, especially when this recurrence involves areas which are difficult to surgically remove tumor from, such as the suprasellar region or cavernous sinuses. We present long term follow-up for a series of 81 patients who underwent repeat surgery for recurrent non-secreting pituitary adenomas. We analyzed data collected from all adult patients undergoing their second microsurgical transsphenoidal resection of a histologically proven endocrine-inactive pituitary adenoma at the University of California at San Francisco between January 1970 and March 2001. Data for these patients were collected by review of medical records, mail, and/or telephone interviews. Visual function, anterior pituitary function, and tumor control rates were analyzed for the series. Records were available for a total of 81 recurrent EIA patients. The median time between their initial and repeat operations was 4.1 years. The mean tumor size was 2.2 +/- 0.2 cm. A total of 35/81 patients had greater than 5 years of follow-up. A total of 24/81 patients had greater than 10 years of follow-up. Over one half of these patients presented with visual disturbance, and we found that 39% of these patients experienced improved vision with a second surgery. More importantly, no one with normal vision suffered any appreciable decline in vision. Approximately, 35% of patients with pre-operative anterior pituitary dysfunction recovered function after surgery in our series; and no patient's function worsened. A total of 4/52 (8%) patients with greater than 2 years of post-op follow-up experienced a clinically meaningful tumor recurrence requiring additional treatment. Our data suggest that when performed by experienced transsphenoidal surgeons, durable tumor control can be obtained in these frequently locally aggressive tumors with acceptable rates of post-operative morbidity.
人们普遍认为，对于大多数无内分泌功能的垂体大腺瘤（EIA），标准的一线治疗方法是手术，通常通过经蝶窦入路。不太清楚的是，当这些肿瘤复发时应该采取什么方法，特别是当这种复发涉及到难以从手术中切除肿瘤的区域时，如鞍上区或海绵窦。我们对 81 例接受复发性无分泌性垂体腺瘤再次手术的患者进行了长期随访。我们分析了 1970 年 1 月至 2001 年 3 月期间在加利福尼亚大学旧金山分校接受第二次经蝶窦显微镜下切除术治疗组织学证实的无内分泌功能的垂体腺瘤的所有成年患者的数据。通过回顾病历、邮件和/或电话访谈收集这些患者的数据。对该系列的视觉功能、垂体前叶功能和肿瘤控制率进行了分析。共有 81 例复发性 EIA 患者的记录。他们首次和再次手术之间的中位时间为 4.1 年。平均肿瘤大小为 2.2 +/- 0.2cm。共有 35/81 例患者的随访时间超过 5 年。共有 24/81 例患者的随访时间超过 10 年。超过一半的患者出现视觉障碍，我们发现 39%的患者在第二次手术后视力有所改善。更重要的是，没有一个视力正常的患者视力明显下降。在我们的系列中，大约 35%的术前垂体前叶功能障碍患者在手术后恢复了功能，而且没有患者的功能恶化。在有 2 年以上术后随访的 4/52（8%）患者中，有 4 例发生了需要额外治疗的有临床意义的肿瘤复发。我们的数据表明，在经验丰富的经蝶窦外科医生的操作下，这些频繁局部侵袭性肿瘤可以获得持久的肿瘤控制，并且术后发病率可以接受。
