Solari Domenico, Zenga Francesco, Angileri Filippo F, Barbanera Andrea, Berlucchi Silvia, Bernucci Claudio, Carapella Carmine, Catapano Domenico, Catapano Giuseppe, Cavallo Luigi M, D'Arrigo Corrado, de Angelis Michelangelo, Denaro Luca, Desogus Nicola, Ferroli Paolo, Fontanella Marco M, Galzio Renato J, Gianfreda Cosimo D, Iacoangeli Maurizio, Lauretti Liverana, Locatelli Davide, Locatelli Marco, Luglietto Davide, Mazzatenta Diego, Menniti Agazio, Milani Davide, Nasi Maria Teresa, Romano Antonio, Ruggeri Andrea G, Saladino Andrea, Santonocito Orazio, Schwarz Andreas, Skrap Miran, Stefini Roberto, Volpin Lorenzo, Wembagher Giulio C, Zoia Cesare, Zona Gianluigi, Cappabianca Paolo
Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy.
Division of Neurosurgery, Università degli Studi di Torino - Città della Salute e della Scienza, Turin, Italy.
World Neurosurg. 2019 Mar;123:e440-e449. doi: 10.1016/j.wneu.2018.11.186. Epub 2018 Nov 27.
Pituitary tumors are a heterogeneous group of lesions that are usually benign. Therefore, a proper understanding of the anatomy, physiology, and pathology is mandatory to achieve favorable outcomes. Accordingly, diagnostic tests and treatment guidelines should be determined and implemented. Thus, we decided to perform a multicenter study among Italian neurosurgical centers performing pituitary surgery to provide an actual depiction from the neurosurgical standpoint.
On behalf of the SINch (Società Italiana di Neurochirurgia), a survey was undertaken with the participants to explore the activities in the field of pituitary surgery within 41 public institutions.
Of the 41 centers, 37 participated in the present study. The total number of neurosurgical procedures performed in 2016 was 1479. Most of the procedures were performed using the transsphenoidal approach (1320 transsphenoidal [1204 endoscopic, 53 microscopic, 53 endoscope-assisted microscopic] vs. 159 transcranial). A multidisciplinary tumor board is convened regularly in 32 of 37 centers, and a research laboratory is present in 18 centers.
Diagnosing pituitary/hypothalamus disorders and treating them is the result of teamwork, composed of several diverse experts. Regarding neurosurgery, our findings have confirmed the central role of the transsphenoidal approach, with preference toward the endoscopic technique. Better outcomes can be expected at centers with a multidisciplinary team and a full, or part of a, residency program, with a greater surgical caseload.
垂体肿瘤是一组异质性病变，通常为良性。因此，要取得良好的治疗效果，必须对其解剖学、生理学和病理学有恰当的理解。相应地，应确定并实施诊断测试和治疗指南。因此，我们决定在意大利进行垂体手术的神经外科中心开展一项多中心研究，从神经外科角度提供实际描述。
代表意大利神经外科学会（SINch），对41家公共机构的参与者进行了一项调查，以探索垂体手术领域的活动情况。
41个中心中，37个参与了本研究。2016年进行的神经外科手术总数为1479例。大多数手术采用经蝶窦入路（1320例经蝶窦手术[1204例内镜手术、53例显微镜手术、53例内镜辅助显微镜手术] 对比159例开颅手术）。37个中心中有32个定期召开多学科肿瘤委员会会议，18个中心设有研究实验室。
诊断和治疗垂体/下丘脑疾病是由多位不同专家组成的团队协作的结果。关于神经外科手术，我们的研究结果证实了经蝶窦入路的核心作用，更倾向于内镜技术。在拥有多学科团队以及完整或部分住院医师培训项目且手术病例量更大的中心，有望取得更好的治疗效果。
