Centre of Surgery for Pituitary Tumours, Department of Neurosurgery, IRCCS Neurological Sciences Institute, Bologna, Italy.
World Neurosurg. 2013 Feb;79(2):327-30. doi: 10.1016/j.wneu.2012.03.018. Epub 2012 Apr 2.
To evaluate the clinical and radiographic manifestations of pituitary metastases (PM), discuss the role of surgery, and briefly review the pertinent literature.
At a single institution between January 1992 and July 2011, 15 patients with PM were surgically treated (all cases were confirmed by histologic analysis). Of patients, 14 complained of visual impairment, 8 complained of headache, 4 complained of ophthalmoplegia, and 11 complained of endocrine disturbances manifesting as diabetes insipidus (7 patients) and anterior hypopituitarism (4 patients).
After transsphenoidal surgery, visual disturbances improved in 12 cases, headache improved in 5 cases, and ophthalmoplegia improved in 2 cases. Endocrinologic function remained unchanged in all cases. The mean survival time was 11.8 months (range, 3-43 months); one patient still survives after 33 months.
The study cohort includes patients representing two clinical situations: (i) patients with a preoperative suspicion of PM and (ii) patients in whom the metastasis was an unexpected finding during surgery performed for a presumed pituitary adenoma. The former situation is indicative of the possibilities and limits of surgery, which may confirm the diagnosis but is only palliative, improving quality of life without improving life expectancy. The latter situation reveals how misleading clinical and radiographic features of PM can be. Considering these results, surgical treatment of PM should be specifically decided based on patient performance status, tumor staging, and patient preference.
评估垂体转移瘤（PM）的临床和影像学表现，讨论手术的作用，并简要回顾相关文献。
在单一机构中，1992 年 1 月至 2011 年 7 月间，对 15 例 PM 患者进行了手术治疗（所有病例均通过组织学分析证实）。患者中，14 例出现视力障碍，8 例出现头痛，4 例出现眼肌麻痹，11 例出现内分泌紊乱，表现为尿崩症（7 例）和垂体前叶功能减退（4 例）。
经蝶窦手术后，12 例视力障碍改善，5 例头痛改善，2 例眼肌麻痹改善。所有患者的内分泌功能均未改变。平均生存时间为 11.8 个月（范围 3-43 个月）；1 例患者在 33 个月后仍存活。
本研究队列包括两种临床情况的患者：（i）术前怀疑有 PM 的患者，（ii）在因疑似垂体腺瘤而进行手术时意外发现转移瘤的患者。前者表明手术的可能性和局限性，虽然可以明确诊断，但仅为姑息性治疗，改善生活质量但不延长预期寿命。后者揭示了 PM 的临床和影像学特征可能存在误导性。考虑到这些结果，PM 的手术治疗应根据患者的体能状态、肿瘤分期和患者的偏好来具体决定。
