Raghu Ashley L B, Flower Hannah D, Statham Patrick F X, Brennan Paul M, Hughes Mark A
Edinburgh Medical School, University of Edinburgh, Edinburgh, Edinburgh, United Kingdom of Great Britain and Northern Ireland.
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland.
J Neurol Surg B Skull Base. 2020 Oct;81(5):579-584. doi: 10.1055/s-0039-1693700. Epub 2019 Jul 24.
As they grow, pituitary adenoma can remodel the sella turcica and alter anatomical relationships with adjacent structures. The intercarotid distance (ICD) at the level of the sella is a measure of sella width. The purpose of this study was to (1) assess how ICD changes after transsphenoidal surgery and (2) explore whether the extent of ICD change is associated with tumor recurrence. A retrospective analysis of preoperative and postoperative coronal magnetic resonance imaging (MRI) scans was carried out by two independent assessors on patients who underwent transsphenoidal surgery for nonfunctioning pituitary macroadenomas. Preoperative tumor volume and any change in ICD following surgery were recorded and compared between groups. Logistic regression models of recurrence were generated. In 36 of 42 patients, ICD fell after surgery (mean = 1.8 mm) and six cases were static. At time of follow-up (mean = 77 months), 25 had not required further intervention and 17 had undergone second surgery or radiosurgery. In patients in whom no further intervention has yet been necessary, the postoperative reduction in ICD was significantly smaller than in those who required repeat intervention (1.1 vs. 2.7 mm respectively, < 0.01). ICD decrease was weakly correlated with tumor volume ( = 0.35). ICD decrease was a significant predictor of recurrence (odds ratio [OR] = 3.15; 95% confidence interval [CI]: 1.44-6.87), largely independent of tumor volume. For most patients, ICD falls following surgical excision of a nonfunctioning pituitary macroadenoma. A greater reduction in ICD postsurgery appears to predict recurrence. Change in ICD shows promise as a radiographic tool for prognosticating clinical course after surgery.
随着垂体腺瘤的生长，它可重塑蝶鞍并改变与相邻结构的解剖关系。蝶鞍水平的颈内动脉间距（ICD）是蝶鞍宽度的一种测量指标。本研究的目的是：（1）评估经蝶窦手术后ICD如何变化；（2）探讨ICD变化程度是否与肿瘤复发相关。
两名独立评估者对接受经蝶窦手术治疗无功能性垂体大腺瘤的患者进行术前和术后冠状位磁共振成像（MRI）扫描的回顾性分析。记录术前肿瘤体积以及术后ICD的任何变化，并在组间进行比较。生成复发的逻辑回归模型。
42例患者中有36例术后ICD下降（平均 = 1.8 mm），6例无变化。在随访时（平均 = 77个月），25例无需进一步干预，17例接受了二次手术或放射外科治疗。在尚未需要进一步干预的患者中，术后ICD的降低明显小于需要重复干预的患者（分别为1.1 vs. 2.7 mm， < 0.01）。ICD降低与肿瘤体积弱相关（ = 0.35）。ICD降低是复发的显著预测因素（比值比[OR] = 3.15；95%置信区间[CI]：1.44 - 6.87），很大程度上独立于肿瘤体积。
对于大多数患者，切除无功能性垂体大腺瘤后ICD会下降。术后ICD更大程度的降低似乎可预测复发。ICD的变化有望作为一种影像学工具来预测手术后的临床病程。
