神经外科医师协会关于无功能垂体腺瘤患者管理的手术技术与技术的系统评价及循证指南

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Surgical Techniques and Technologies for the Management of Patients With Nonfunctioning Pituitary Adenomas.

作者信息

Kuo John S, Barkhoudarian Garni, Farrell Christopher J, Bodach Mary E, Tumialan Luis M, Oyesiku Nelson M, Litvack Zachary, Zada Gabriel, Patil Chirag G, Aghi Manish K

机构信息

‡Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin; §Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California; ¶Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania; ‖Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; #Barrow Neurological Institute, Phoenix, Arizona; **Department of Neurosurgery, Emory University, Atlanta, Georgia; ‡‡Department of Neurosurgery, George Washington University, Washington, DC; §§Department of Neurological Surgery, University of Southern California, Los Angeles, California; ¶¶Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California; ‖‖Department of Neurosurgery, University of California, San Francisco, San Francisco, California.

出版信息

Neurosurgery. 2016 Oct;79(4):E536-8. doi: 10.1227/NEU.0000000000001390.

DOI:10.1227/NEU.0000000000001390

PMID:27635962

Abstract

BACKGROUND

Numerous technological adjuncts are used during transsphenoidal surgery for nonfunctioning pituitary adenomas (NFPAs), including endoscopy, neuronavigation, intraoperative magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) diversion, and dural closure techniques.

OBJECTIVE

To generate evidence-based guidelines for the use of NFPA surgical techniques and technologies.

METHODS

An extensive literature search spanning January 1, 1966, to October 1, 2014, was performed, and only articles pertaining to technological adjuncts for NFPA resection were included. The clinical assessment evidence-based classification was used to ascertain the class of evidence.

RESULTS

Fifty-six studies met the inclusion criteria, and evidence-based guidelines were formulated on the use of endoscopy, neuronavigation, intraoperative MRI, CSF diversion, and dural closure techniques.

CONCLUSION

Both endoscopic and microscopic transsphenoidal approaches are recommended for symptom relief in patients with NFPAs, with the extent of tumor resection improved by adequate bony exposure and endoscopic visualization. In select cases, combined transcranial and transsphenoidal approaches are recommended. Although intraoperative MRI can improve gross total resection, its use is associated with an increased false-positive rate and is thus not recommended. There is insufficient evidence to recommend the use of neuronavigation, CSF diversion, intrathecal injection, or specific dural closure techniques. The full guidelines document for this chapter can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_6.

ABBREVIATIONS

CSF, cerebrospinal fluidNFPA, nonfunctioning pituitary adenoma.

摘要

背景

在经蝶窦手术治疗无功能性垂体腺瘤（NFPA）的过程中，会使用多种技术辅助手段，包括内镜检查、神经导航、术中磁共振成像（MRI）、脑脊液（CSF）分流以及硬脑膜闭合技术。

目的

制定基于证据的NFPA手术技术和技术应用指南。

方法

进行了一项广泛的文献检索，涵盖1966年1月1日至2014年10月1日期间的文献，仅纳入与NFPA切除技术辅助手段相关的文章。采用基于临床评估证据的分类方法来确定证据等级。

结果

56项研究符合纳入标准，并制定了关于内镜检查、神经导航、术中MRI、CSF分流以及硬脑膜闭合技术应用的基于证据的指南。

结论

对于NFPA患者，推荐采用内镜和显微镜经蝶窦入路来缓解症状，通过充分的骨质暴露和内镜可视化可提高肿瘤切除程度。在特定情况下，推荐采用经颅和经蝶窦联合入路。虽然术中MRI可提高全切率，但其应用会增加假阳性率，因此不推荐使用。目前尚无足够证据推荐使用神经导航、CSF分流、鞘内注射或特定的硬脑膜闭合技术。本章的完整指南文件可在https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_6获取。