Zoli Matteo, Milanese Laura, Faustini-Fustini Marco, Guaraldi Federica, Asioli Sofia, Zenesini Corrado, Righi Alberto, Frank Giorgio, Foschini Maria Pia, Sturiale Carmelo, Pasquini Ernesto, Mazzatenta Diego
Center of Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
Center of Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
World Neurosurg. 2017 Oct;106:331-338. doi: 10.1016/j.wneu.2017.06.117. Epub 2017 Jun 30.
The optimal management of pituitary apoplexy (PA) remains debated. The aim of this study was to assess the outcome of the transsphenoidal approach for PA in a large surgical experience.
Each consecutive case of PA consecutively operated by endoscopic endonasal approach from our tertiary care center, from 1998 to 2015, was included in this series.
Seventy-five patients (47 male; mean age 52.4 ± 16.2 years) were included. Mean follow-up was 69.3 ± 46.7 months. On admission, all patients presented with abrupt severe headache (100%), associated with anterior hypopituitarism in 51 patients (68%), visual disturbances in 55 (73.4%), ophthalmoplegia in 38 (50.7%), and a remarkable reduction of consciousness in 2 (2.6%). Apoplexy proved to be ischemic in 35 patients (46.7%) and hemorrhagic in 40 (53.3%). Patients with hemorrhagic necrosis presented more often with major suprasellar expansion (P = 0.012) Radical removal was achieved in 60 cases (80%). Surgical morbidity consisted in one case of postoperative cerebrospinal fluid leak (1.3%). Anterior hypopituitarism worsened in 15 cases (20%), and diabetes insipidus occurred in 4 cases (5.3%). Ophthalmoplegia improved/normalized in 71% and visual symptoms in 85.5% of the patients, with better results achieved in ischemic forms (P = 0.043). The 2 comatose patients regained normal consciousness.
The endoscopic endonasal approach represents a valid, effective, and safe technique in the management of PA. Favorable outcomes can be achieved by referring patients to dedicated pituitary centers with a multidisciplinary team. Further studies are still needed to define criteria for surgical indication and to identify outcome predictors.
垂体卒中（PA）的最佳治疗方案仍存在争议。本研究旨在通过大量手术经验评估经蝶窦入路治疗PA的效果。
本系列纳入了1998年至2015年在我们三级医疗中心连续接受内镜鼻内入路手术的每一例PA患者。
共纳入75例患者（47例男性；平均年龄52.4±16.2岁）。平均随访时间为69.3±46.7个月。入院时，所有患者均突发剧烈头痛（100%），51例（68%）伴有垂体前叶功能减退，55例（73.4%）有视觉障碍，38例（50.7%）有眼肌麻痹，2例（2.6%）意识明显减退。35例（46.7%）的卒中为缺血性，40例（53.3%）为出血性。出血性坏死患者更常出现鞍上大的占位（P = 0.012）。60例（80%）实现了根治性切除。手术并发症包括1例术后脑脊液漏（1.3%）。15例（20%）垂体前叶功能减退加重，4例（5.3%）发生尿崩症。71%的患者眼肌麻痹改善/恢复正常，85.5%的患者视觉症状改善，缺血性类型的效果更好（P = 0.043）。2例昏迷患者恢复了正常意识。
内镜鼻内入路是治疗PA的一种有效、安全的技术。将患者转诊至配备多学科团队的专业垂体中心可取得良好效果。仍需进一步研究以确定手术指征标准并识别预后预测因素。
