Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México City, México.
World Neurosurg. 2011 Feb;75(2):286-93. doi: 10.1016/j.wneu.2010.08.002.
To classify patterns of descent of the diaphragma sellae (DS) to the sella turcica after transsphenoidal resection of pituitary macroadenomas and to determine whether there is any correlation between type of descent and volume or growth pattern of the tumor, as well as the presence of any postoperative hormone alteration, cerebrospinal fluid leak, and/or residual tumor.
One hundred patients with pituitary macroadenomas in which microsurgical transsphenoidal approach was indicated were prospectively included. We classified patterns of descent of the DS into four types: type A: symmetrical descent with a central fold corresponding to the pituitary stalk; type B: asymmetrical with a lateralized fold; type C: symmetrical and uniform descent without any fold; and type D: minimal or no descent in absence of visible residual tumor. A correlation was made between these types of descent and clinical and radiological findings.
The largest tumors were types A and B; endocrine deficit was more frequent in types A and C, whereas the possibility of residual tumor was more elevated in types B and D. No statistically significant differences were found regarding tumor morphology and cerebrospinal fluid leakage.
Our results suggest that pattern of descent of the DS may serve as a reference to determine the risk of leaving residual tumor as well as the possibility of developing postoperative endocrine deficit. It is apparent that tumor volume, more than morphology, is the main factor determining type of descent of the DS.
对经蝶窦切除垂体大腺瘤后鞍隔（DS）向鞍底的下降模式进行分类，并确定下降类型与肿瘤体积或生长方式、术后激素改变、脑脊液漏和/或残留肿瘤之间是否存在任何相关性。
前瞻性纳入 100 例经蝶窦显微手术指征的垂体大腺瘤患者。我们将 DS 的下降模式分为四种类型：A 型：对称下降，与垂体柄相对应的中央折叠；B 型：不对称，有侧化折叠；C 型：对称且均匀下降，无任何折叠；D 型：无明显下降，无可见残留肿瘤。对这些下降类型与临床和影像学发现之间进行相关性分析。
最大的肿瘤为 A 型和 B 型；A 型和 C 型内分泌功能减退更常见，而 B 型和 D 型残留肿瘤的可能性更高。肿瘤形态和脑脊液漏方面无统计学差异。
我们的结果表明，DS 的下降模式可作为参考，以确定残留肿瘤的风险以及术后发生内分泌功能减退的可能性。显然，决定 DS 下降类型的主要因素是肿瘤体积，而不是形态。
