Departments of 1 Neurosurgery and.
Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia; and.
J Neurosurg. 2017 Mar;126(3):889-896. doi: 10.3171/2016.3.JNS152735. Epub 2016 May 20.
OBJECTIVE The object of this study was to compare the outcomes of primary and revision transsphenoidal resection (TSR) of nonfunctioning pituitary macroadenomas (NFPMAs) using endoscopic methods. METHODS The authors retrospectively reviewed the records of 287 consecutive patients who had undergone endoscopic endonasal TSR for NFPMAs at their institution in the period from 2005 to 2011. Fifty patients who had undergone revision TSR were retrospectively matched for age, sex, and duration of follow-up to 46 patients who had undergone primary TSR. Medical and surgical complications were documented, and Kaplan-Meier analysis was performed to assess rates of radiological progression-free survival (PFS). RESULTS The median follow-up periods were 45 and 46 months for the primary and revision TSR groups, respectively. There were no significant differences between the primary and revision groups in rates of new neurological deficit (0 in each), vascular injury (2% vs 0), postoperative CSF leak (6% vs 2%), transient diabetes insipidus (DI; 15% vs 12%), chronic DI (2% vs 2%), chronic sinusitis (4% vs 6%), meningitis (2% vs 2%), epistaxis (7% vs 0), or suprasellar hematoma formation (0 vs 2%). However, patients who underwent primary TSR had significantly higher rates of syndrome of inappropriate antidiuretic hormone (SIADH; 17% vs 4%, p = 0.04). Patients who underwent primary operations also had significantly higher rates of gross-total resection (GTR; 63% vs 28%, p < 0.01) and significantly lower rates of adjuvant radiotherapy (13% vs 42%, p < 0.01). Radiological PFS rates were similar at 2 years (98% vs 96%) and 5 years (87% vs 80%, p = 0.668, log-rank test). CONCLUSIONS Patients who underwent primary TSR of NFPMAs experienced higher rates of SIADH than those who underwent revision TSR. Patients who underwent revision TSR were less likely to have GTR of their tumor, although they still had a PFS rate similar to that in patients who underwent primary TSR. This finding may be attributable to an increased rate of adjuvant radiation treatment to subtotally resected tumors in the revision TSR group.
本研究旨在比较内镜经鼻蝶窦入路治疗无功能垂体大腺瘤（NFPMAs）的初次手术与翻修手术的结果。
作者回顾性分析了 2005 年至 2011 年期间在本机构接受内镜经鼻蝶窦入路治疗 NFPMAs 的 287 例连续患者的病历。对 50 例接受翻修手术的患者进行了回顾性匹配，以年龄、性别和随访时间与 46 例接受初次手术的患者相匹配。记录了医疗和手术并发症，并进行 Kaplan-Meier 分析以评估影像学无进展生存率（PFS）。
初次手术和翻修手术组的中位随访时间分别为 45 个月和 46 个月。在新的神经功能缺损发生率（各为 0）、血管损伤发生率（2%对 0）、术后脑脊液漏发生率（6%对 2%）、一过性尿崩症（DI；15%对 12%）、慢性 DI（2%对 2%）、慢性鼻窦炎（4%对 6%）、脑膜炎（2%对 2%）、鼻出血（7%对 0）或鞍上血肿形成（0 对 2%）方面，初次手术组和翻修手术组之间无显著差异。然而，初次手术组患者的抗利尿激素分泌不当综合征（SIADH；17%对 4%，p = 0.04）发生率显著更高。初次手术患者的大体全切除率（GTR；63%对 28%，p < 0.01）显著更高，辅助放疗率（13%对 42%，p < 0.01）显著更低。在 2 年（98%对 96%）和 5 年（87%对 80%）时，影像学 PFS 率相似（p = 0.668，对数秩检验）。
初次经蝶窦入路治疗 NFPMAs 的患者比接受翻修手术的患者更容易发生 SIADH。尽管接受翻修手术的患者肿瘤 GTR 的可能性较小，但他们的 PFS 率与初次手术患者相似。这一发现可能归因于翻修手术组接受部分切除肿瘤辅助放疗的比例增加。
