Department of Neurosurgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
Department of Pathology and Clinical Laboratory, Nagoya University Hospital, Nagoya, Aichi, Japan.
Pituitary. 2019 Oct;22(5):507-513. doi: 10.1007/s11102-019-00980-w.
Functional pituitary adenomas (FPAs) lacking a well-defined pseudocapsule can invade the adjacent pituitary gland. In such situations, peel-off resection of the adjacent pituitary gland after selective adenomectomy might lead to complete tumor removal, resulting in optimal endocrinological outcomes. Here, we present the significance of peel-off resection of the pituitary gland in patients with FPA in whom complete extracapsular tumor removal cannot be achieved.
We performed a retrospective review of 21 patients with FPA who underwent transsphenoidal surgery (TSS). After selective adenomectomy, peel-off resection of the adjacent pituitary gland was performed in 13 patients because complete extracapsular resection could not be achieved, while peel-off resection was not performed in the remaining 8 patients because complete extracapsular resection was accomplished. The clinical outcomes of these groups were compared. The pituitary tissues obtained by peel-off resection were pathologically examined for tumor cells.
Early postoperative biochemical remission was achieved in 20 patients (95.2%). Anterior pituitary functions were not aggravated postoperatively in any patient: however, transient diabetes insipidus (DI) occurred in 2 patients. There were no statistically significant differences in the clinical outcomes of the two groups. A pseudocapsule was pathologically detected in the adjacent anterior pituitary even in patients in whom no pseudocapsule was intraoperatively detected. Tumor cells were pathologically detected in 7 (58.3%) of 12 pituitary tissues examined.
Peel-off resection of the pituitary gland, which can remove a small tumor cell remnant in the adjacent pituitary, might maximize the effectiveness of TSS with minimal impact on postoperative pituitary function.
缺乏明确假包膜的功能性垂体腺瘤（FPAs）可侵犯相邻的垂体。在这种情况下，选择性腺瘤切除术（adenomectomy）后进行毗邻垂体的剥离切除术（peel-off resection）可能会导致肿瘤完全切除，从而获得最佳的内分泌学结果。在此，我们提出了在无法实现完整囊外肿瘤切除的情况下，对 FPAs 患者进行毗邻垂体剥离切除术的意义。
我们对 21 例行经蝶窦手术（TSS）的 FPAs 患者进行了回顾性研究。在选择性腺瘤切除术后，由于无法实现完整囊外切除，13 例患者进行了毗邻垂体的剥离切除术，而在另外 8 例患者中未进行剥离切除术，因为已完成了完整囊外切除。比较了这两组患者的临床结果。对剥离切除的垂体组织进行肿瘤细胞的病理学检查。
20 例患者（95.2%）术后早期实现了生化缓解。无患者术后出现前垂体功能恶化：然而，2 例患者出现了短暂性尿崩症（DI）。两组的临床结果无统计学差异。即使在术中未检测到假包膜的患者中，毗邻的前垂体也在病理学上检测到了假包膜。对 12 例检查的垂体组织中的 7 例（58.3%）进行了肿瘤细胞的病理学检测。
毗邻垂体的剥离切除术可以去除毗邻垂体中残留的少量肿瘤细胞，在不影响术后垂体功能的情况下，最大限度地提高 TSS 的疗效。
