Alsumali Adnan, Cote David J, Regestein Quentin R, Crocker Erin, Alzarea Abdulaziz, Zaidi Hasan A, Bi Wenya Linda, Dawood Hassan Y, Broekman Marike L, van Zandvoort Martine J E, Mekary Rania A, Smith Timothy R
MCPHS University, 179 Longwood Ave., Boston, MA, USA.
Cushing Neurosurgery Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Harvard Medical School, 15 Francis Street, Boston, MA, USA.
J Clin Neurosci. 2017 Aug;42:1-6. doi: 10.1016/j.jocn.2017.01.015. Epub 2017 Feb 16.
Cognitive impairment following transsphenoidal surgery (TSS) among patients with pituitary tumors has been intermittently reported and is not well established. We performed a systematic review to summarize the impact of TSS on cognitive function.
We conducted a systematic search of the literature using the PubMed, Cochrane, and Embase databases through October 2014. Studies were selected if they reported cognitive status after surgery and included at least 10 adult patients with pituitary tumors undergoing either endoscopic or microscopic TSS.
After removing 69 duplicates, 758 articles were identified, of which 24 were selected for full text review after screening titles and abstracts. After reviewing full texts, nine studies with a combined total of 682 patients were included in the final analysis. Eight studies were cross-sectional and one was longitudinal. These studies used a wide variety of neurocognitive tests to assess memory, attention and executive function post-operatively. Of the eight studies, six reported impairments in verbal and non-verbal memory post-operatively, while others found no association related to memory, and some reported an improvement in episodic, verbal, or logical memory. While four studies found an impaired association between TSS and attention or executive function, another four studies did not.
The current literature on cognitive impairments after TSS is limited and inconsistent. This review demonstrates that patients undergoing TSS may experience a variety of effects on executive function and memory post-operatively, but changes in verbal memory are most common.
垂体瘤患者经蝶窦手术（TSS）后出现认知障碍的情况时有报道，但尚未完全明确。我们进行了一项系统综述，以总结TSS对认知功能的影响。
我们通过PubMed、Cochrane和Embase数据库对截至2014年10月的文献进行了系统检索。如果研究报告了手术后的认知状态，并且纳入了至少10例接受内镜或显微镜下TSS的成年垂体瘤患者，则将其纳入研究。
在去除69篇重复文献后，共识别出758篇文章，其中24篇在筛选标题和摘要后被选入全文综述。在审阅全文后，最终分析纳入了9项研究，共计682例患者。8项研究为横断面研究，1项为纵向研究。这些研究使用了多种神经认知测试来评估术后的记忆、注意力和执行功能。在8项研究中，6项报告术后言语和非言语记忆受损，而其他研究未发现与记忆相关的关联，还有一些研究报告情景记忆、言语记忆或逻辑记忆有所改善。虽然4项研究发现TSS与注意力或执行功能之间存在受损关联，但另外4项研究未发现此关联。
目前关于TSS后认知障碍的文献有限且不一致。本综述表明，接受TSS的患者术后可能在执行功能和记忆方面经历多种影响，但言语记忆的变化最为常见。
