Giordano Mario, Samii Amir, Fahlbusch Rudolf
Department of Neurosurgery, International Neuroscience Institute-Hannover, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany.
Leibniz Institute for Neurobiology, Brenneckestrasse 6, 39118, Magdeburg, Germany.
Neurosurg Rev. 2018 Oct;41(4):999-1005. doi: 10.1007/s10143-017-0940-y. Epub 2017 Dec 30.
We report our experience about somatotrophinomas without clinical manifestation of acromegaly having radiological- and surgical-verified invasion of the cavernous sinus. We present the clinical, radiological and hormonal status of three patients affected by invasive GH-secreting pituitary adenomas without clinical signs and symptoms of acromegaly with elevation of serum IGF-1 from a series of 142 pituitary adenomas operated in our institute with the aid of intraoperative magnetic resonance imaging (MRI). Total tumor removal was possible in two of the three cases; the patients show normal hormonal status and no recurrence at long-term follow-up. In the third case, due to the different features of the tumor, complete resection was not possible and a multimodal treatment was performed that allowed regularization of the hormonal status and control of the residual tumor. GH-secreting adenomas without clinical manifestation of acromegaly are uncommon lesions. Total microsurgical excision can be curative. However, in case of partial removal, a tailored adjuvant treatment should be considered to preserve the quality of life of the patient and avoid regrowth of the lesion. In not resectable tumors, preoperative medical treatment with somatostatin analogues is always an option.
我们报告了关于无肢端肥大症临床表现但经影像学和手术证实侵犯海绵窦的生长激素瘤的经验。我们呈现了3例侵袭性生长激素分泌型垂体腺瘤患者的临床、影像学和激素状况，这些患者无肢端肥大症的临床体征和症状，血清胰岛素样生长因子-1（IGF-1）升高，来自于我们研究所借助术中磁共振成像（MRI）手术治疗的142例垂体腺瘤病例系列。3例中的2例实现了肿瘤全切；患者激素状况正常，长期随访无复发。在第3例中，由于肿瘤的不同特征，无法完全切除，因此进行了多模式治疗，使激素状况恢复正常并控制了残留肿瘤。无肢端肥大症临床表现的生长激素分泌型腺瘤是罕见病变。全显微手术切除可能治愈。然而，在部分切除的情况下，应考虑量身定制的辅助治疗，以维持患者生活质量并避免病变复发。对于不可切除的肿瘤，术前使用生长抑素类似物进行药物治疗始终是一种选择。
