Department of Neurological Surgery, Weill Cornell Medical College, New York–Presbyterian Hospital, New York, New York 10021, USA.
Neurosurg Focus. 2011 Apr;30(4):E10. doi: 10.3171/2011.1.FOCUS10317.
The purpose of this study was to analyze preoperative predictors of endocrinological remission following endonasal endoscopic resection of therapy-resistant prolactin-, growth hormone (GH)-, and adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas and to establish benchmarks for cure by using the most recent consensus criteria.
The authors reviewed a prospective database of 86 consecutive functional pituitary adenomas that were resected by a purely endoscopic endonasal transsphenoidal technique. Extent of resection was evaluated on postoperative contrast-enhanced MR imaging. Endocrinological remission was defined according to the most recent consensus criteria.
The majority of functional adenomas (62.8%) were classified as macroadenomas (> 1 cm in maximum diameter), and 20.9% of lesions had invaded the cavernous sinus (CS) at the time of surgery. A gross-total resection was achieved in 75.6% of all patients. The rate of endocrinological remission differed between various types of functional adenomas. Cure rates were 92.3% (microadenomas) and 57.1% (macroadenomas) for prolactinomas, 75% (microadenomas) and 40% (macroadenomas) for GH-secreting tumors, and 54.5% (microadenomas) and 71.4% (macroadenomas) for ACTH-secreting tumors. Lower rates of cure occurred in GH-secreting macroadenomas due to a high rate of CS invasion, and in ACTH-secreting adenomas due to a high rate of lesions that were not visible on preoperative MR imaging. Whereas univariate analysis showed that macroadenoma, suprasellar, cavernous extension, or extent of resection correlated with cure, on multivariate analysis, only extent of resection and suprasellar extension predicted cure. One patient developed postoperative meningitis that was complicated by hydrocephalus requiring a ventriculoperitoneal shunt. Two patients developed postoperative panhypopituitarism, and 2 patients suffered from CSF leaks, which were treated with lumbar CSF diversion.
This paper reports benchmarks for endocrinological cure as well as complications in a large series of purely endoscopic pituitary surgeries by using the most recent consensus criteria. The advantages of extended endonasal approaches are most profound in tumors with suprasellar extension and CS invasion.
本研究旨在分析经鼻内镜切除治疗抵抗型泌乳素瘤、生长激素（GH）瘤和促肾上腺皮质激素（ACTH）瘤后内分泌缓解的术前预测因素，并使用最新的共识标准为治愈建立基准。
作者回顾了 86 例连续功能性垂体腺瘤患者的前瞻性数据库，这些患者均通过纯内镜经鼻蝶窦技术进行了切除。术后增强磁共振成像评估切除程度。内分泌缓解根据最新的共识标准定义。
大多数功能性腺瘤（62.8%）被归类为大腺瘤（最大直径> 1 厘米），20.9%的病变在手术时已侵犯海绵窦（CS）。所有患者的大体全切除率为 75.6%。不同类型的功能性腺瘤的内分泌缓解率不同。泌乳素瘤的治愈率为 92.3%（微腺瘤）和 57.1%（大腺瘤），GH 分泌性肿瘤为 75%（微腺瘤）和 40%（大腺瘤），ACTH 分泌性肿瘤为 54.5%（微腺瘤）和 71.4%（大腺瘤）。由于 CS 侵犯率高，GH 分泌性大腺瘤的治愈率较低，由于术前 MRI 上可见的病变率高，ACTH 分泌性腺瘤的治愈率较低。单因素分析显示，大腺瘤、鞍上、海绵窦延伸或切除程度与治愈率相关，多因素分析显示，只有切除程度和鞍上延伸预测了治愈率。1 例患者术后发生脑膜炎，并发脑积水，需行脑室-腹腔分流术。2 例患者发生术后全垂体功能减退症，2 例患者发生脑脊液漏，经腰椎脑脊液分流治疗。
本文报告了使用最新共识标准的大系列纯内镜垂体手术的内分泌学治愈基准以及并发症。扩展经鼻入路的优势在具有鞍上延伸和 CS 侵犯的肿瘤中最为明显。
