Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Neurosurgery, University of Paris, Lariboisière Hospital, Paris, France.
Department of Public Health Evaluation, University Paris Diderot, Paris, France.
World Neurosurg. 2021 Feb;146:e341-e350. doi: 10.1016/j.wneu.2020.10.083. Epub 2020 Oct 22.
Endoscopic endonasal approaches (EEAs) provide improved access and operative visualization for resection of pituitary adenomas. Although the technique has gained wide acceptance, there is a paucity of data regarding late recurrence.
We aim to assess long-term outcomes of patients with nonfunctioning pituitary adenomas (NFPAs) who underwent EEA.
We reviewed 269 patients operated on for an NFPA between 2005 and 2015. Clinical and radiologic factors including those potentially related to higher chances of recurrence were analyzed. Progression-free survival was analyzed using the Kaplan-Meier method, and univariate and multivariate survival were analyzed using a Cox regression model.
The study included 269 patients. The gross total resection rate was 46.0% (n = 124) but cavernous sinus involvement was present in almost half the patients (n = 115). The probability of recurrence at 5 years and 10 years was 22.0% and 47.2%, respectively. The median time to recurrence was 10 years for patients without cavernous sinus involvement and 6 years for those with cavernous sinus involvement. Univariate and multivariate analysis showed that tumor size, cavernous sinus invasion, anterior skull base extensions, and residual tumor were significantly associated with recurrence.
Recurrence rate of NFPA remains high despite the better visualization offered by EEA, especially in those tumors involving the cavernous sinus and/or previously operated on. Repeat surgery is adequate for tumor debulking and decompression of the optic apparatus but is unlikely to achieve gross total resection if a successful previous EEA has been performed. Radiation therapy is an effective option for management of recurrent tumors.
内镜经鼻入路（EEA）为切除垂体腺瘤提供了更好的入路和手术可视化效果。尽管该技术已被广泛接受，但关于晚期复发的资料却很少。
我们旨在评估接受 EEA 治疗的无功能垂体腺瘤（NFPAs）患者的长期结果。
我们回顾了 2005 年至 2015 年间接受手术治疗的 269 例 NFPAs 患者。分析了包括与更高复发几率相关的临床和影像学因素等潜在相关因素。采用 Kaplan-Meier 方法分析无进展生存率，采用 Cox 回归模型进行单变量和多变量生存分析。
本研究共纳入 269 例患者。大体全切除率为 46.0%（n=124），但几乎一半的患者（n=115）存在海绵窦受累。5 年和 10 年的复发率分别为 22.0%和 47.2%。无海绵窦受累患者的复发中位时间为 10 年，而有海绵窦受累患者的复发中位时间为 6 年。单变量和多变量分析表明，肿瘤大小、海绵窦侵犯、前颅底延伸和残留肿瘤与复发显著相关。
尽管 EEA 提供了更好的可视化效果，但 NFPAs 的复发率仍然很高，特别是在那些涉及海绵窦和/或先前已接受手术的肿瘤。如果先前的 EEA 手术成功，再次手术仅足以进行肿瘤减瘤和视神经减压，但不太可能实现大体全切除。放射治疗是治疗复发性肿瘤的有效选择。
