Pennacchietti Valentina, Garzaro Massimiliano, Grottoli Silvia, Pacca Paolo, Garbossa Diego, Ducati Alessandro, Zenga Francesco
Division of Neurosurgery, Department of Neurosciences, A. O. U. Città della Salute e della Scienza di Torino, Turin, Italy.
Division of Ear, Nose and Throat 1, Department of Surgical Sciences, A. O. U. Città della Salute e della Scienza di Torino, Turin, Italy.
World Neurosurg. 2016 May;89:121-5. doi: 10.1016/j.wneu.2016.01.049. Epub 2016 Feb 1.
Pituitary tumors account for approximately 15% of primary intracranial neoplasms and often are diagnosed incidentally. Common sellar lesions are pituitary adenomas, craniopharyngiomas, and Rathke cleft cysts. Currently endoscopic transsphenoidal approaches are largely used, and many centers also use 3-dimensional (3D) technology, although additional results of long-term follow-up are still being accumulated.
We present a retrospective analysis of 104 patients with sellar lesions (57 male and 47 female, mean age 52 years) who underwent 3D endoscopic transsphenoidal surgery in our center from December 2011 to March 2015 and were followed up for a mean time of 18 months.
A total of 16 patients were diagnosed with growth hormone-secreting adenomas, 9 with adrenocorticotropic hormone-secreting, 5 with prolactin-secreting, and 2 with thyroid-stimulating hormone-secreting tumors and 58 with nonsecreting pituitary adenomas. Five patients had Rathke cleft cysts, 5 craniopharyngiomas, 2 fibrous solitary tumors, 1 a metastasis, and 1 a chordoma. At baseline, 47 patients (45.2%) had hormonal changes and 52 (50%) had visual field changes. Complete resection was achieved in 73 patients (70.1%). Follow-up evaluation detected hormonal remission in 7 patients with Cushing disease (77.7%) and in 11 patients with acromegaly (68.7%). Complications were cerebrospinal fluid leak in 5 cases (4.8%) and transient diabetes insipidus in 6 cases (5.7%). A total of 55 patients (52.9%) were discharged less than 72 hours after surgery.
The use of an endoscopic endonasal approach with 3D technology provides several advantages relating to patient length of stay, rate of complications, postoperative recovery, and novice surgeons' training. Advantages of 3D endoscopy and long-term follow-up still need further elucidation.
垂体瘤约占原发性颅内肿瘤的15%，常为偶然发现。常见的鞍区病变有垂体腺瘤、颅咽管瘤和拉克氏囊肿。目前，内镜经蝶入路应用广泛，许多中心也采用三维（3D）技术，不过长期随访的更多结果仍在积累中。
我们对2011年12月至2015年3月在本中心接受3D内镜经蝶手术的104例鞍区病变患者（男57例，女47例，平均年龄52岁）进行回顾性分析，平均随访时间为18个月。
共16例患者诊断为生长激素分泌型腺瘤，9例为促肾上腺皮质激素分泌型，5例为催乳素分泌型，2例为促甲状腺激素分泌型肿瘤，58例为无分泌功能的垂体腺瘤。5例患者有拉克氏囊肿，5例有颅咽管瘤，2例有纤维性孤立性肿瘤，1例有转移瘤，1例有脊索瘤。基线时，47例患者（45.2%）有激素变化，52例（50%）有视野改变。73例患者（70.1%）实现了全切。随访评估发现7例库欣病患者（77.7%）和11例肢端肥大症患者（68.7%）激素缓解。并发症包括5例脑脊液漏（4.8%）和6例短暂性尿崩症（5.7%）。共有55例患者（52.9%）术后不到72小时出院。
采用带3D技术的鼻内镜入路在患者住院时间、并发症发生率、术后恢复及新手外科医生培训方面有诸多优势。3D内镜的优势及长期随访仍需进一步阐明。
