Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
Division of Endocrinology, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA; USC Pituitary Center, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
World Neurosurg. 2020 May;137:e366-e372. doi: 10.1016/j.wneu.2020.01.204. Epub 2020 Feb 4.
The management of pituitary apoplexy, caused by acute hemorrhage and/or infarction of a pituitary adenoma, is debated.
To analyze clinical characteristics of patients undergoing endoscopic endonasal approaches (EEAs) for pituitary apoplexy.
A retrospective review of patients at our institution from 2012 to 2018 undergoing EEA for pituitary apoplexy diagnosed clinically and with imaging/pathologic findings. Analysis included demographics, symptoms, neuroendocrine deficits, neuroimaging, complications, symptom resolution, and follow-up details.
Fifty patients (mean age, 53 years) were included. Preoperative symptoms included headache (86%), vision loss (62%), and cranial nerve paresis (40%). Mean tumor diameter was 2.7 cm and extrasellar extension was observed in 96% of tumors. Twenty-eight tumors were hemorrhagic (76%), 24 were necrotic (65%), and 13 (35%) had both features. Magnetic resonance imaging showed gross total resection in 58% of patients. Headache and vision loss improved in 87% and 86% of presenting patients. Cranial nerve paresis resolved in 72% of patients, partially improved in 11%, and remained unchanged in 17%. There were no deaths or carotid artery injuries. Surgical complications included postoperative cerebrospinal fluid leak (n = 4, 8%), epistaxis (n = 2, 4%), postoperative abscess (n = 1, 2%), and transient postoperative vision loss requiring reoperation (n = 1, 4%). Endocrinopathies improved in 21% of patients and panhypopituitarism persisted in 48% and developed in 6% of patients. Mean follow-up time was 26 months; 2 patients experienced recurrence.
EEA for pituitary apoplexy is effective in rapidly improving headache and visual symptoms. Although neuro-ophthalmic deficits often improve over time, panhypopituitarism persists in most patients after surgical resection.
由于垂体腺瘤的急性出血和/或梗死引起的垂体卒中的治疗存在争议。
分析经内镜经鼻入路（EEA）治疗垂体卒中患者的临床特征。
回顾性分析了 2012 年至 2018 年期间在我院接受 EEA 治疗的临床和影像学/病理学诊断为垂体卒中的患者。分析包括人口统计学、症状、神经内分泌缺陷、神经影像学、并发症、症状缓解和随访细节。
共纳入 50 例患者（平均年龄 53 岁）。术前症状包括头痛（86%）、视力下降（62%）和颅神经麻痹（40%）。肿瘤平均直径为 2.7cm，96%的肿瘤有鞍外扩展。28 例肿瘤为出血性（76%），24 例为坏死性（65%），13 例（35%）同时具有两种特征。磁共振成像显示 58%的患者肿瘤全切除。87%的患者头痛和视力下降得到改善，86%的患者得到改善。72%的患者颅神经麻痹得到缓解，11%的患者部分缓解，17%的患者无变化。无死亡或颈动脉损伤。手术并发症包括术后脑脊液漏（n=4，8%）、鼻出血（n=2，4%）、术后脓肿（n=1，2%）和术后短暂性视力丧失需再次手术（n=1，4%）。21%的患者内分泌功能改善，48%的患者持续存在全垂体功能减退，6%的患者出现全垂体功能减退。平均随访时间为 26 个月；2 例患者复发。
EEA 治疗垂体卒中可迅速改善头痛和视觉症状。尽管神经眼科缺陷随着时间的推移往往会改善，但大多数患者在手术切除后仍存在全垂体功能减退。
