Buchfelder Michael, Weigel Daniel, Nimsky Christopher
a University of Erlangen-Nürnberg, Department of Neurosurgery, Erlangen, Germany.
b University of Erlangen-Nürnberg, Department of Neurosurgery, Erlangen, Germany.
Expert Rev Endocrinol Metab. 2007 Mar;2(2):251-259. doi: 10.1586/17446651.2.2.251.
Small nonfunctioning pituitary (micro)adenomas are encountered frequently as incidental findings. Large (macro)adenomas present with visual compromise, hypopituitarism or headache. Indications for surgery include loss of vision, diplopia, other symptoms of a space occupying intracranial lesion and documented tumor progression during serial imaging. Their primary treatment is surgical resection. To exclude medical treatment options, a preoperative endocrinological investigation is mandatory. To date, more than 90% of operations in patients with nonfunctioning pituitary adenomas are performed via the transsphenoidal route. There are several variations of transnasal surgery available, with and without dissection of the nasal septum. Only tumors where the predominant mass lesion is essentially located outside the sella require transcranial operations. These are usually performed via a frontotemporal or frontolateral craniotomy. Surgical decompression of visual pathways is usually followed by a rapid improvement of vision. Whether or not the tumor mass can be completely resected depends on the size and localization of the adenoma and the surgical expertise. Several patients experience an improvement of pituitary function. Potential complications of surgery include loss of vision, vascular injury, cerebrospinal fluid fistula, meningitis and hypopituitarism. Modern technical developments, such as the use of the endoscope, intraoperative magnetic resonance imaging and neuronavigation, are being increasingly appreciated by neurosurgeons throughout the world.
小型无功能垂体（微）腺瘤常作为偶然发现被频繁遇到。大型（巨）腺瘤则表现为视力受损、垂体功能减退或头痛。手术指征包括视力丧失、复视、颅内占位性病变的其他症状以及在系列影像学检查中记录到的肿瘤进展。其主要治疗方法是手术切除。为排除药物治疗选项，术前进行内分泌学检查是必需的。迄今为止，超过90%的无功能垂体腺瘤患者的手术是通过经蝶窦途径进行的。经鼻手术有多种变体，可进行或不进行鼻中隔解剖。只有主要肿块基本位于蝶鞍外的肿瘤才需要开颅手术。这些手术通常通过额颞或额外侧开颅进行。对视神经通路进行手术减压后，视力通常会迅速改善。肿瘤肿块能否完全切除取决于腺瘤的大小和位置以及手术技术。一些患者的垂体功能会有所改善。手术的潜在并发症包括视力丧失、血管损伤、脑脊液漏、脑膜炎和垂体功能减退。现代技术发展，如内窥镜的使用、术中磁共振成像和神经导航，正越来越受到世界各地神经外科医生的重视。
