Bodhinayake Imithri, Ottenhausen Malte, Mooney Michael A, Kesavabhotla Kartik, Christos Paul, Schwarz Justin T, Boockvar John A
Weill Cornell Brain Tumor Center, Department of Neurosurgery, Weill Medical College of Cornell University, New York, USA.
Weill Cornell Brain Tumor Center, Department of Neurosurgery, Weill Medical College of Cornell University, New York, USA.
Clin Neurol Neurosurg. 2014 Apr;119:75-9. doi: 10.1016/j.clineuro.2014.01.020. Epub 2014 Jan 27.
Endoscopic endonasal (EE) transsphenoidal surgery is an important surgical approach to the treatment of sellar pathology, particularly for pituitary adenomas. Risk factors for the radiographic recurrence of pituitary adenomas resected using a purely endoscopic approach have not been established. This study investigates outcomes and identifies risk factors for recurrence following EE transsphenoidal surgery for pituitary adenoma.
We performed a retrospective review of 64 patients with pituitary adenomas undergoing EE surgery by a single, right-handed surgeon preferentially operating through the right nares. Post-operative MRI studies were utilized to monitor for residual disease or disease recurrence.
Residual tumor was found in 31.2% of patients. Over a median follow-up period of 23.1 months (range 4-62.5), 4 (20%) of these patients showed recurrence. Two patients with inconclusive post-operative imaging had subsequent imaging consistent with recurrence, making the total recurrence in our series 9.4%. While no statistically significant effects of gender, age or history of previous treatment were seen, amenorrhea on presentation and maximum tumor diameter >10 mm were significant risk factors for radiographic recurrence (p = 0.044 and 0.005, respectively). No predominant side of residual tissue was identified in these tumors operated through the right nares.
Only 20% of patients with residual tumor developed recurrent disease over a median follow up of 23.1 months. This recurrence rate may be an important consideration in cases where gross total resection is not feasible. Preferentially operating from the right does not seem to influence the location of residual tumor.
鼻内镜经鼻（EE）经蝶窦手术是治疗鞍区病变的重要手术方法，尤其是垂体腺瘤。采用单纯内镜手术切除垂体腺瘤后影像学复发的危险因素尚未明确。本研究调查了EE经蝶窦垂体腺瘤手术后的结果，并确定复发的危险因素。
我们对64例接受EE手术的垂体腺瘤患者进行了回顾性研究，手术由一位惯用右手的外科医生进行，优先通过右侧鼻孔操作。术后MRI检查用于监测残留疾病或疾病复发。
31.2%的患者发现有残留肿瘤。在中位随访期23.1个月（范围4 - 62.5个月）内，这些患者中有4例（20%）出现复发。2例术后影像学结果不明确的患者随后的影像学检查结果与复发一致，使我们系列研究中的总复发率为9.4%。虽然未发现性别、年龄或既往治疗史有统计学意义的影响，但出现闭经和最大肿瘤直径>10 mm是影像学复发的显著危险因素（分别为p = 0.044和0.005）。在通过右侧鼻孔手术的这些肿瘤中，未发现残留组织的优势侧。
在中位随访23.1个月期间，仅有20%的残留肿瘤患者出现疾病复发。在无法进行全切除的情况下，这一复发率可能是一个重要的考虑因素。优先从右侧操作似乎不影响残留肿瘤的位置。
