Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th Street, Box 99, New York, NY 10021, USA.
Pituitary. 2012 Sep;15(3):450-63. doi: 10.1007/s11102-011-0350-z.
Endoscopy in combination with extended approaches allow for resection of large pituitary adenomas via a transsphenoidal route. The objective of the current study was to determine a volumetric threshold for lesions with high perioperative morbidity and high rate of subtotal resection following endonasal endoscopic surgery. Thus, we analyzed a prospectively collected database of 71 patients who underwent endoscopic transsphenoidal approaches for macroadenomas (diameter >1 cm). Extend of resection (EOR) was calculated based on volumetric analysis of pre-and post-operative contrast-enhanced MRI. Average EOR was 97.8% and a gross total resection (GTR) was achieved in 76.1% of all patients. GTR was accomplished in 92.0% versus 38.1% of adenomas either without or with CS invasion, respectively. Likewise, GTR was accomplished in 90.2% versus 40.0% of lesions less than or greater then 10 cm(3) respectively. However, even if only subtotal resection was achieved, 90.3% of tumor volume was removed. At 17 months follow-up, visual field defects improved in 80.8% of patients. Complications included permanent diabetes insipidus (5 patients), panhypopituitarism (4 patients), injury to the ophthalmic artery (1 patient) and CSF leak (1 patient). On multivariate logistic regression, two factors negatively predicted GTR: invasion of the CS and volume greater than 10 cm(3). A 10 cm(3) threshold was a stronger predictor of EOR and complication risk than diameter-based measurements. A volume greater than 10 cm(3) and CS invasion may help to identify pituitary lesions associated with a higher likelihood of subtotal resection and post-operative morbidity.
内镜检查结合扩展方法可通过经蝶窦途径切除大型垂体腺瘤。本研究的目的是确定经鼻内镜手术后具有高围手术期发病率和次全切除率的病变的体积阈值。因此，我们分析了 71 例接受内镜经蝶窦入路治疗大腺瘤（直径> 1 cm）的前瞻性数据库。切除程度（EOR）根据术前和术后增强 MRI 的体积分析计算。平均 EOR 为 97.8％，所有患者中均实现了大体全切除（GTR），分别为 92.0％和 38.1％。无或有海绵窦侵犯的腺瘤分别实现了 90.2％和 40.0％的 GTR。同样，小于或大于 10 cm3的病变分别实现了 90.2％和 40.0％的 GTR。但是，即使仅实现了次全切除，也有 90.3％的肿瘤体积被切除。在 17 个月的随访中，80.8％的患者视野缺损得到改善。并发症包括永久性尿崩症（5 例），垂体功能减退（4 例），眼动脉损伤（1 例）和脑脊液漏（1 例）。多元逻辑回归分析表明，两个因素对 GTR 有负面影响：CS 侵犯和体积大于 10 cm3。体积大于 10 cm3是比基于直径的测量更能预测 EOR 和并发症风险的因素。体积大于 10 cm3和 CS 侵犯可能有助于识别与次全切除和术后发病率较高相关的垂体病变。
