Department of Neurosurgery and Gamma Knife Radiosurgery, Vita-Salute University, Scientific Institute San Raffaele, Milan, Italy.
Department of Pediatrics, Vita-Salute University, Scientific Institute San Raffaele, Milan, Italy.
Neurosurgery. 2019 Jul 1;85(1):65-74. doi: 10.1093/neuros/nyy204.
Young age has been reported as a negative prognostic factor for pituitary adenomas (PAs). They are very uncommon in children and adolescents; therefore, surgical outcomes are poorly described.
To report results of microsurgical transsphenoidal approach (MTSA) in pediatric PAs.
The study retrospectively analyzed 3040 PAs treated in our institute, according to the adenoma subtype and then divided into pediatric (≤18 yr) and adult groups (>18 yr). The average follow-up after surgery was 58 mo (n = 2906).
In the pediatric group, the majority of adenomas were hormone-secreting (89.5%) with a female sex prevalence (78%) in prolactinomas and nonfunctioning pituitary adenomas (NFPAs); the maximum diameter of growth hormone (GH)-secreting adenomas was greater (28.1 ± 4.1 mm) than in adults (18 ± 0.3 mm, P = .002). Surgical remission rate at 6 mo was similar in both groups for all adenoma subtypes: 72.1% and 76% in pediatric and adult Cushing's disease, 69.3% and 59.3% in prolactinomas, 55.6% and 61% in gigantism or acromegaly, 55.6% and 61.5% in NFPAs. Recurrences after remission occurred more frequently in pediatric GH-secreting adenomas compared to adults (40.0% vs 5.3%, P = .028) despite similar follow-up (38 ± 17 and 48.1 ± 2.2 mo, P = .7). Mortality was zero in the pediatric and 0.2% in the adult group (P = .7); major morbidity was 2.4% and 2.2%, respectively (P = .8).
MTSA was safe and effective in children and adolescents as in adults, with the only exception of higher recurrence rate in pediatric GH-secreting adenomas. No complications related to young age appeared.
年龄较轻被报道为垂体腺瘤（PA）的一个负面预后因素。它们在儿童和青少年中非常罕见；因此，手术结果描述得很差。
报告经蝶窦显微外科手术（MTSA）治疗儿科 PA 的结果。
该研究回顾性分析了在我们研究所治疗的 3040 例 PA，根据腺瘤亚型分为儿科（≤18 岁）和成年组（>18 岁）。手术后的平均随访时间为 58 个月（n = 2906）。
在儿科组中，大多数腺瘤是激素分泌性的（89.5%），催乳素瘤和无功能垂体腺瘤（NFPAs）中女性患病率较高（78%）；生长激素（GH）分泌性腺瘤的最大直径较大（28.1 ± 4.1 mm），大于成人（18 ± 0.3 mm，P =.002）。在两组中，所有腺瘤亚型的 6 个月时手术缓解率相似：库欣病儿童和成人分别为 72.1%和 76%，催乳素瘤分别为 69.3%和 59.3%，巨人症或肢端肥大症分别为 55.6%和 61%，NFPAs 分别为 55.6%和 61.5%。缓解后复发在儿科 GH 分泌性腺瘤中比成人更常见（40.0%比 5.3%，P =.028），尽管随访时间相似（38 ± 17 和 48.1 ± 2.2 个月，P =.7）。儿科组死亡率为零，成年组为 0.2%（P =.7）；主要发病率分别为 2.4%和 2.2%（P =.8）。
MTSA 在儿童和青少年中与在成年人中一样安全有效，唯一的例外是儿科 GH 分泌性腺瘤的复发率较高。没有出现与年龄有关的并发症。
