Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Al-Azhar University Faculty of Medicine-Nasr city, Cairo, Egypt.
World Neurosurg. 2019 Aug;128:e752-e759. doi: 10.1016/j.wneu.2019.04.250. Epub 2019 May 8.
The availability of magnetic resonance imaging (MRI) has led to an increase in the detection of pituitary incidentaloma (PI). However, there are no robust data on surgical treatment of PI on which to base therapeutic recommendations. This study was performed to investigate the significance of surgery for asymptomatic nonfunctioning pituitary adenoma (NFPA) among PIs.
A total of 180 patients that underwent tumor resection of pituitary adenoma via the transsphenoidal approach between 2005 and 2017 were reviewed. Thirty-three consecutive patients with subjectively asymptomatic NFPA were included in this study. Our surgical indications for asymptomatic NFPAs were categorized as follows: macroadenoma with optic chiasma compression (group A, n = 14), solid tumor ≥2 cm in size (group B, n = 7), and tumor growth on follow-up MRI (group C, n = 12). The clinical outcomes were analyzed accordingly.
Seven patients (50%) in group A showed subjective improvement of visual function after tumor resection even though they had no complaints preoperatively. On the other hand, no changes occurred in any cases in group B or group C. Although there were no critical complications in this series, the incidence of nonnegligible nasal complications was relatively high (24.2%) and may decrease the patient's quality of life.
Surgery should be recommended for asymptomatic NFPA with optic chiasma compression to improve visual outcome. On the other hand, immediate intervention for other asymptomatic NFPA to reduce the likelihood of the appearance of tumor-related symptoms remains questionable considering its invasiveness to the nose.
磁共振成像（MRI）的出现导致了垂体意外瘤（PI）的检出率增加。然而，目前尚无关于PI 手术治疗的可靠数据，无法据此提出治疗建议。本研究旨在探讨手术治疗无症状无功能垂体腺瘤（NFPA）在 PI 中的意义。
回顾了 2005 年至 2017 年间经蝶窦入路行肿瘤切除术的 180 例垂体腺瘤患者。本研究纳入了 33 例连续的主观无症状 NFPA 患者。我们对无症状 NFPA 的手术适应证进行了分类：视交叉受压的大腺瘤（A 组，n=14）、直径≥2cm 的实性肿瘤（B 组，n=7）和肿瘤在 MRI 随访中生长（C 组，n=12）。并对其进行了相应的临床结果分析。
A 组 7 例（50%）患者肿瘤切除后视觉功能有主观改善，尽管术前无任何主诉。另一方面，B 组或 C 组的任何病例均无变化。尽管本研究无严重并发症，但不可忽视的鼻部并发症发生率相对较高（24.2%），可能会降低患者的生活质量。
对于有视交叉受压的无症状 NFPA，手术应被推荐以改善视觉结果。另一方面，对于其他无症状 NFPA，考虑到对鼻子的侵袭性，立即进行干预以降低出现与肿瘤相关的症状的可能性仍存在疑问。
