Brain and Spinal Injury Research Center (BASIR), Pituitary Clinic, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurological Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
World Neurosurg. 2019 Dec;132:e802-e811. doi: 10.1016/j.wneu.2019.08.004. Epub 2019 Aug 9.
Surgical treatment of large and giant pituitary adenomas is challenging and associated with higher risk of complications and lower rate of gross total resection. We present our experience with surgical management of large and giant adenomas using the extended endoscopic transsphenoidal approach (EETA).
A total of 80 patients with large (30-39 mm) and giant (≥40 mm) pituitary adenomas who underwent tumor resection using EETA were studied. Radiologic data, hormonal and visual status, surgical outcomes, complications, and factors affecting the extent of resection were evaluated.
Forty-five tumors (56.3%) were classified as large and 35 (43.8%) as giant adenomas. Gross total resection was achieved in 66 patients (82.5%), near-total resection in 10 (12.5%), and subtotal resection in 4 (5%). Preoperative factors including larger tumor size, multilobular shape of tumor, and higher Knosp scores significantly decrease the likelihood of gross total resection. Of patients with preoperative visual acuity impairment and visual field deficit, 76.8% and 74.1%, respectively, experienced improvement after surgery. The most common complications include new pituitary insufficiency (16.4%), permanent diabetes insipidus (7.5%), and cerebrospinal fluid leakage (5%). Two cases of meningitis (2.5%) and 3 deaths (3.8%) occurred in this cohort of patients. Mean follow-up duration was 24.2 months.
EETA can be a safe and efficient approach as the first-line treatment of patients with large and giant pituitary adenomas and is associated with high rates of gross total resection or near-total resection, visual function improvement, and a relatively low rate of complications.
大型和巨大型垂体腺瘤的手术治疗具有挑战性，并且与更高的并发症风险和更低的大体全切除率相关。我们报告了使用扩展内镜经蝶窦入路（EETA）治疗大型和巨大型腺瘤的手术经验。
共研究了 80 例接受 EETA 肿瘤切除术的大型（30-39mm）和巨大型（≥40mm）垂体腺瘤患者。评估了影像学资料、激素和视力状况、手术结果、并发症以及影响切除程度的因素。
45 个肿瘤（56.3%）被归类为大型，35 个肿瘤（43.8%）为巨大型腺瘤。66 例（82.5%）患者达到大体全切除，10 例（12.5%）达到近全切除，4 例（5%）达到次全切除。术前因素包括肿瘤较大、肿瘤多叶形状和较高的 Knosp 评分显著降低了大体全切除的可能性。术前视力障碍和视野缺损的患者中，分别有 76.8%和 74.1%在手术后得到改善。最常见的并发症包括新发垂体功能不全（16.4%）、永久性尿崩症（7.5%）和脑脊液漏（5%）。该患者队列中有 2 例（2.5%）脑膜炎和 3 例（3.8%）死亡。平均随访时间为 24.2 个月。
EETA 可以作为大型和巨大型垂体腺瘤患者的一线治疗方法，安全有效，具有较高的大体全切除或近全切除率、视力功能改善和相对较低的并发症发生率。
