Department of Surgery, Songshan Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Minimally Invasive Skull Base Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Minimally Invasive Skull Base Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Physical Therapy, Hung Kuang University, Taichung, Taiwan.
World Neurosurg. 2019 Jun;126:e41-e47. doi: 10.1016/j.wneu.2019.01.125. Epub 2019 Feb 2.
Long-term effects of endoscopic endonasal transsphenoidal intracapsular debulking and adjuvant somatostatin analogs (SSAs) were evaluated in patients with growth hormone- (GH) secreting pituitary macroadenomas.
We retrospectively reviewed the medical records of 45 patients with acromegalic macroadenoma who underwent endonasal endoscopic transsphenoidal intracapsular debulking and received adjuvant SSAs (octreotide) between 2006 and 2015 who had >1 year of follow-up. To evaluate the predictive factors for 1 year and long-term biochemical outcomes, univariate and multivariate analyses were performed.
Biochemical remission was achieved in 1 year in 20 of the 45 (44.4%) patients, and in 31 of the 45 patients after long-term adjuvant SSA treatment. Tumor control was achieved in 43 of the 45 (93.3%) patients. The univariate analysis showed age (≥55 years), tumor size (diameter ≤1.5 cm), premedication GH levels (≤2.8 ng/mL), premedication insulin-like growth factor 1 levels (≤2-fold of upper limit of normal range), cavernous sinus invasion (Knops grades 2, 3, and 4), and near-total tumor resection were associated with long-term outcomes. The multivariate analysis showed near-total resection was a significant predictor for long-term outcomes (P = 0.019). There were no new pituitary dysfunctions. The observed complications included one case of cerebrospinal fluid leakage and one case of epistaxis requiring intervention.
Intracapsular debulking and adjuvant SSAs are a safe and viable treatment for patients with GH secreting pituitary macroadenoma to achieve biochemical remission and tumor control. Although adjuvant SSA treatment enhances residual tumor control, cavernous sinus invasion impedes the remission of endocrine tumors.
评估生长激素（GH）分泌性垂体大腺瘤患者经内镜经鼻蝶窦内囊内切除术和辅助生长抑素类似物（SSA）治疗的长期效果。
我们回顾性分析了 2006 年至 2015 年间接受经鼻内镜蝶窦内囊内切除术和辅助 SSA（奥曲肽）治疗且随访时间超过 1 年的 45 例肢端肥大症性大腺瘤患者的病历。为了评估 1 年和长期生化结局的预测因素，我们进行了单因素和多因素分析。
45 例患者中，20 例（44.4%）在 1 年内获得生化缓解，31 例（45 例中有 31 例）在长期辅助 SSA 治疗后获得生化缓解。45 例患者中，43 例（93.3%）肿瘤得到控制。单因素分析显示年龄（≥55 岁）、肿瘤大小（直径≤1.5 cm）、术前 GH 水平（≤2.8 ng/mL）、术前胰岛素样生长因子 1 水平（≤正常范围上限的 2 倍）、海绵窦侵袭（Knops 分级 2、3 和 4）和近全肿瘤切除与长期结局相关。多因素分析显示，近全切除是长期结局的显著预测因素（P = 0.019）。没有新发垂体功能障碍。观察到的并发症包括 1 例脑脊液漏和 1 例需要干预的鼻出血。
囊内切除术和辅助 SSA 是治疗 GH 分泌性垂体大腺瘤患者以实现生化缓解和肿瘤控制的安全可行的治疗方法。尽管辅助 SSA 治疗可增强残余肿瘤控制，但海绵窦侵袭会阻碍内分泌肿瘤的缓解。
