Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Japan.
Pituitary. 2017 Oct;20(5):531-538. doi: 10.1007/s11102-017-0814-x.
Although hemorrhage within pituitary adenomas frequently exacerbates the symptoms, there are many grades of severity. Moreover, the contributing factors for symptom severity are still controversial.
This retrospective study included 82 patients who underwent transsphenoidal surgery for pituitary adenomas with intratumoral hemorrhage. The grades of preoperative symptoms were classified into group A, asymptomatic or minor symptoms; group B, moderate symptoms sufficient for complain; and group C, severe symptoms disturbing daily life.
The hemorrhage volume within an adenoma was significantly higher in group C (92.6%) than in groups A (48.6%) and B (58.7%). Both headache and diplopia were dominant in group C, occurring in 72.2% and 27.8% of the patients, respectively. In group C, there was no significant difference in frequency between adenoma extensions into the sphenoid sinus (0%) and involvement of the cavernous sinus of Knosp grade 4 (0%), and extensions into the suprasellar region were not common (38.9%). The most distinctive feature was that "no extrasellar extension" was found only in group C (41.2%), and "multidirectional extension" was not detected in this group (0%). Multiple regression analysis revealed that the most powerful determining factors were the high frequencies of intratumoral hemorrhage and lack of extrasellar and multidirectional extensions.
Rapid volume expansion of a hematoma and lack of extension or unidirectional extension might lead to significant compression of the sellar and surrounding structures. Of note, the integrity of the sellar dura might contribute to the acute onset of symptom manifestations caused by hemorrhage in pituitary adenomas.
尽管垂体腺瘤内出血常使症状恶化，但严重程度有许多等级。此外，导致症状严重程度的因素仍存在争议。
本回顾性研究纳入了 82 例因垂体腺瘤内出血而行经蝶窦手术的患者。术前症状的严重程度分为 A 组（无症状或症状轻微）、B 组（中度症状足以抱怨）和 C 组（严重症状干扰日常生活）。
C 组（92.6%）腺瘤内出血量明显高于 A 组（48.6%）和 B 组（58.7%）。头痛和复视在 C 组中均占主导地位，分别为 72.2%和 27.8%的患者。C 组中，肿瘤向蝶窦内延伸（0%）和海绵窦受累 Knosp 分级 4（0%）的频率无显著差异，向鞍上区域延伸也不常见（38.9%）。最显著的特征是 C 组仅发现“无鞍外延伸”（41.2%），且未发现“多向延伸”（0%）。多因素回归分析显示，最有力的决定因素是肿瘤内出血频率高且无鞍外和多向延伸。
血肿的快速体积膨胀和缺乏延伸或单向延伸可能导致鞍区和周围结构的显著压迫。值得注意的是，鞍底硬脑膜的完整性可能有助于解释垂体腺瘤出血引起的症状突然发作。
