Departments of1Neurosurgery and.
Departments of2Neurosurgery and.
J Neurosurg. 2020 Jun 5;134(6):1808-1815. doi: 10.3171/2020.4.JNS192778. Print 2021 Jun 1.
The authors investigated the natural history of asymptomatic nonfunctioning pituitary adenomas (NFPAs) with optic nerve compression.
This study retrospectively analyzed the natural history of asymptomatic NFPAs with documented optic nerve compression on MRI diagnosed between 2000 and 2016 from 2 institutions. The patients were followed up with regular endocrinological, ophthalmological, and radiological evaluations, and the endpoint was new endocrinopathy or neurological deficits.
The study comprised 81 patients. The median age at diagnosis was 58.0 years and the follow-up duration was 60.0 months. As the denominator of overall pituitary patients, 2604 patients were treated with surgery after diagnosis at the 2 institutions during the same period. The mean initial and last measured values for tumor diameter were 23.7 ± 8.9 mm and 26.2 ± 11.4 mm, respectively (mean ± SD). Tumor growth was observed in 51 (63.0%) patients; however, visual deterioration was observed in 14 (17.3%) patients. Ten (12.3%) patients experienced endocrine deterioration. Fourteen (17.3%) patients underwent surgery for either visual deterioration (in 12 patients) or endocrine dysfunction (in 2 patients). After surgery, all patients experienced improvements in visual or hormonal function. The actuarial rates of treatment-free survival at 2, 3, and 5 years were 96.1%, 93.2%, and 85.6%, respectively. In the multivariate analysis, initial cavernous sinus invasion (HR 4.985, 95% CI 1.597-15.56; p = 0.006) was the only independent risk factor for eventual treatment.
The neuroendocrinological deteriorations were not frequent and could be recovered by surgery with early detection on regular follow-up in asymptomatic NFPAs with documented optic nerve compression on MRI. Therefore, conservative management could be an acceptable strategy for these tumors. Careful follow-up is required for tumors with cavernous sinus invasion.
作者研究了伴有视神经压迫的无症状无功能垂体腺瘤（NFPAs）的自然病史。
本研究回顾性分析了 2000 年至 2016 年期间 2 家机构诊断为 MRI 显示伴有视神经压迫的无症状 NFPAs 的自然病史。患者接受了定期的内分泌、眼科和影像学评估，终点是新发内分泌疾病或神经功能缺损。
本研究共纳入 81 例患者。诊断时的中位年龄为 58.0 岁，随访时间为 60.0 个月。作为同期 2 家机构诊断后接受手术治疗的所有垂体瘤患者的分母，2604 例患者接受了手术治疗。肿瘤直径的初始和末次测量平均值分别为 23.7±8.9mm 和 26.2±11.4mm（平均值±标准差）。51 例（63.0%）患者观察到肿瘤生长；然而，14 例（17.3%）患者出现视觉恶化。10 例（12.3%）患者出现内分泌恶化。由于视觉恶化（12 例）或内分泌功能障碍（2 例），14 例（17.3%）患者接受了手术治疗。手术后，所有患者的视觉或激素功能均得到改善。2、3、5 年无治疗生存的累积率分别为 96.1%、93.2%和 85.6%。多变量分析显示，初始海绵窦侵犯（HR 4.985，95%CI 1.597-15.56；p=0.006）是最终治疗的唯一独立危险因素。
在 MRI 显示伴有视神经压迫的无症状 NFPAs 中，神经内分泌恶化并不常见，通过定期随访早期发现并进行手术治疗，可以恢复神经内分泌功能。因此，对于这些肿瘤，保守治疗可能是一种可接受的策略。对于伴有海绵窦侵犯的肿瘤需要进行仔细的随访。
