Hwang Joo Min, Kim Yong Hwy, Kim Jin Wook, Kim Dong Gyu, Jung Hee-Won, Chung Young Seob
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Korean Neurosurg Soc. 2013 Oct;54(4):317-22. doi: 10.3340/jkns.2013.54.4.317. Epub 2013 Oct 31.
The surgical approach for recurrent pituitary adenoma after trans-sphenoidal approach (TSA) is challenging. We report the outcomes of the endoscopic TSA for recurrent pituitary adenoma after microscopic TSA.
From February 2010 to February 2013, endoscopic TSA was performed for removal of 30 recurrent pituitary adenomas after microscopic TSA. Twenty-seven (90%) patients had a clinically non-functioning pituitary adenoma. Twenty-four (80%) patients suffered from a visual disturbance related to tumor growth. The clinical features and surgical outcomes were retrospectively analyzed for the ophthalmological, endocrinological, and oncological aspects.
The mean tumor volume was 11.7 cm(3), and gross total resection was achieved in 50% of patients. The volumetric analysis based on the postoperative MR showed that the mean extent of resection rates were 90%. Vision was improved in 19 (79%) of 24 patients with visual symptoms, and endocrinological cure was achieved in all of three functioning pituitary adenomas; however, the post-operative follow-up endocrinological examination revealed a new endocrinological deficit in one patient. Two patients required antibiotics management for post-operative meningitis.
The endoscopic TSA can be an effective treatment option for recurrent pituitary adenoma after microscopic TSA with acceptable outcome.
经蝶窦入路（TSA）后复发性垂体腺瘤的手术入路具有挑战性。我们报告了显微镜下TSA后复发性垂体腺瘤的内镜TSA治疗结果。
2010年2月至2013年2月，对30例显微镜下TSA后复发性垂体腺瘤患者进行了内镜TSA切除。27例（90%）患者为临床无功能垂体腺瘤。24例（80%）患者因肿瘤生长出现视力障碍。对眼科、内分泌科和肿瘤科方面的临床特征及手术结果进行回顾性分析。
肿瘤平均体积为11.7 cm³，50%的患者实现了肿瘤全切除。基于术后磁共振成像的体积分析显示，平均切除率为90%。24例有视觉症状的患者中，19例（79%）视力得到改善，3例功能性垂体腺瘤患者均实现内分泌治愈；然而，术后随访内分泌检查发现1例患者出现新的内分泌功能减退。2例患者因术后脑膜炎需要抗生素治疗。
内镜TSA对于显微镜下TSA后的复发性垂体腺瘤可能是一种有效的治疗选择，且疗效可接受。
