Department of Neurosurgery, University Hospital Erlangen, Germany.
J Neurosurg. 2013 Dec;119(6):1447-52. doi: 10.3171/2013.8.JNS13790. Epub 2013 Sep 27.
Volume reduction of nonfunctioning pituitary adenomas has been described, for example, after radiotherapy and pituitary tumor apoplexy. Even when considerable remnants remain after surgery, spontaneous shrinkage and relief of mass lesion symptoms can sometimes occur. The aim of this study was to assess shrinkage of tumor residues after transsphenoidal surgery and to identify predictors of tumor shrinkage.
A total of 140 patients with postoperative remnants of nonfunctioning pituitary adenomas treated at the Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany, were included in this study. All patients underwent transsphenoidal procedures with guidance by 1.5-T intraoperative MRI. The intraoperative images of remnants were compared with images taken at 3 months and at 1 year after surgery. The possible predictors analyzed were age; sex; preoperative and intraoperative tumor dimensions; tumor growth pattern; endocrinological, ophthalmological, and histological characteristics; and history of previous pituitary surgery. For statistical analyses, the Fisher's exact test, Mann-Whitney U-test, and multivariate regression table analysis were used.
Follow-up imaging 3 months after surgery showed tumor remnant shrinkage of 0.5 ± 0.6 cm3 for 70 (50%) patients. This reduction was 89% ± 20% of the residual volume depicted by intraoperative MRI. In 45 (64%) patients, the remnants disappeared completely. Age, sex, and preoperative tumor volume did not significantly differ between the shrinkage and no-shrinkage groups. Positive predictors for postoperative shrinkage were cystic tumor growth (p = 0.02), additional resection of tumor remnants guided by intraoperative MRI (p = 0.04), smaller tumor volume (p = 0.04), and smaller craniocaudal tumor diameter of remnants (p = 0.0014). Negative predictors were growth into the cavernous sinus (p = 0.009), history of previous pituitary surgery (p = 0.0006) and tumor recurrence (p = 0.04), and preoperative panhypopituitarism (p = 0.04). Multivariate regression analysis indicated a positive correlation between tumor shrinkage and smaller tumor remnants (p < 0.0001) and no history of previous pituitary surgery (p = 0.003). No spontaneous change in tumor remnant volume was detected between 3 months and 1 year postoperatively. During a mean follow-up time of 2.7 years, 1 (2%) patient with postoperative tumor shrinkage had to undergo another operation because of tumor progression.
Spontaneous volume reduction of nonfunctioning pituitary adenoma remnants can occur within 3 months after surgery. Predictors of shrinkage are smaller tumor remnant volume and no history of previous pituitary surgery.
例如，在放射治疗和垂体瘤卒中后，无功能垂体腺瘤的体积已经减少。即使在手术后仍有相当大的残余物，肿瘤也会自发缩小并缓解肿块症状。本研究的目的是评估经蝶窦手术后肿瘤残余物的缩小，并确定肿瘤缩小的预测因素。
本研究共纳入德国埃尔兰根大学医院神经外科治疗的 140 例术后无功能垂体腺瘤残余患者。所有患者均接受了 1.5-T 术中 MRI 引导的经蝶窦手术。术中残余物图像与术后 3 个月和 1 年的图像进行比较。分析的可能预测因素包括年龄、性别、术前和术中肿瘤大小、肿瘤生长模式、内分泌、眼科和组织学特征以及既往垂体手术史。统计学分析采用 Fisher 精确检验、Mann-Whitney U 检验和多变量回归表分析。
术后 3 个月的随访影像学显示，70 例（50%）患者的肿瘤残余物缩小了 0.5±0.6cm3。这相当于术中 MRI 显示的残余体积的 89%±20%。45 例（64%）患者的残余物完全消失。肿瘤缩小组和无肿瘤缩小组的年龄、性别和术前肿瘤体积无显著差异。术后肿瘤缩小的阳性预测因素包括囊性肿瘤生长（p=0.02）、术中 MRI 引导下切除肿瘤残余物（p=0.04）、肿瘤体积较小（p=0.04）和残余肿瘤颅尾径较小（p=0.0014）。阴性预测因素包括肿瘤向海绵窦生长（p=0.009）、既往垂体手术史（p=0.0006）和肿瘤复发（p=0.04）以及术前全垂体功能减退（p=0.04）。多变量回归分析表明，肿瘤缩小与肿瘤残余物较小（p<0.0001）和无既往垂体手术史（p=0.003）呈正相关。术后 3 个月至 1 年，肿瘤残余体积无自发变化。在平均 2.7 年的随访中，1 例（2%）肿瘤缩小的患者因肿瘤进展需要再次手术。
无功能垂体腺瘤残余物可在术后 3 个月内自发缩小。肿瘤缩小的预测因素是肿瘤残余体积较小和无既往垂体手术史。
