Guo Fuyou, Song Laijun, Bai Jie, Zhao Peichao, Sun Hongwei, Liu Xianzhi, Yang Bo, Wang Shukai
Department of Neurosurgery, The First Affiliated Hospital of ZhengZhou University, ZhengZhou, HeNan Province, PR China.
Clin Neurol Neurosurg. 2012 Sep;114(7):885-90. doi: 10.1016/j.clineuro.2012.01.033. Epub 2012 Feb 10.
Giant pituitary adenomas (GPAs) remain a therapeutic challenge with high mortality and morbidity. We described our experience in a consecutive series of GPAs with extensive suprasellar extension.
A series of 15 consecutive patients with maximum dimension of more than 4cm was enrolled in present study. These cases were microsurgically treated through diverse transcranial approach in our neurosurgical department from January 2006 to January 2011. Four different transcranial microsurgical approaches were selected based on tumor localization and expansion as well as neurosurgeon's experience.
Gross total removal (GTR) was achieved in 10 of all patients (67%), subtotal removal was achieved in 5 of 15 (33%). Nine patients experienced visual improvement postoperatively compared with those of preoperative symptom (82%), no intraoperative or postoperative death was observed in present series. The most striking features of this study indicate that an experienced team can reach 67% with no mortality, no panhypopituitarism and no permanent diabetes insipidus dealing with GPAs. No recurrent tumor was found in the GPAs with GTR, adjuvant radiation therapy had been performed in 5 patients and the continuous shrinkage of the residual adenomas was achieved in 2 out of 5 with radiotherapy.
Transcranial approach was still a relatively reliable and safe management for complex GPAs with extensive suprasellar extension.
巨大垂体腺瘤（GPA）仍然是一个具有高死亡率和发病率的治疗挑战。我们描述了我们在一系列伴有广泛鞍上扩展的GPA患者中的经验。
本研究纳入了连续15例最大直径超过4cm的患者。这些病例于2006年1月至2011年1月在我们神经外科通过不同的经颅入路进行显微手术治疗。根据肿瘤定位、扩展情况以及神经外科医生的经验选择了四种不同的经颅显微手术入路。
所有患者中有10例（67%）实现了肿瘤全切除（GTR），15例中有5例（33%）实现了次全切除。与术前症状相比，9例患者术后视力有所改善（82%），本系列中未观察到术中或术后死亡。本研究最显著的特点表明，一个经验丰富的团队在处理GPA时，肿瘤全切除率可达67%，且无死亡率、无垂体功能减退和无永久性尿崩症。在肿瘤全切除的GPA患者中未发现复发病例，5例患者接受了辅助放疗，其中2例放疗后残余腺瘤持续缩小。
经颅入路对于伴有广泛鞍上扩展的复杂GPA仍是一种相对可靠和安全的治疗方法。
