Department of Neurosurgery, Medical University of South Carolina, 301 CSB, Charleston, SC, USA.
Department of NeuroOncology, Moffitt Cancer Center, Tampa, FL, USA.
Acta Neurochir (Wien). 2021 Jun;163(6):1725-1734. doi: 10.1007/s00701-020-04674-2. Epub 2021 Jan 5.
The evolution of pituitary surgery has made it a safe and effective form of treatment; however, risks of inadequate tumor resection, cerebrospinal fluid (CSF) leak, pituitary dysfunction, and vascular injury still exist. The use of intraoperative ultrasonography (IOUS) in pituitary surgery has been well described. Recent advancements in ultrasound technology have allowed for expanded utility as described here.
A retrospective review was performed between January 2016 and December 2019. One hundred thirty-eight patients (mean age 53.7 years, 47% females) were identified undergoing transsphenoidal surgery for pituitary tumors. Thirty-four patients had IOUS performed using a side-firing ultrasound probe, while 104 did not. Data was analyzed for preoperative (demographics, clinical, and radiographic features), perioperative (blood loss, operative time), and postoperative (complications, length of stay, hormone remission, and extent of resection) outcomes.
There were no significant differences in patient age, gender, tumor volume, Knosp grade, and hormone-secreting status between the two groups. Patients treated using IOUS had significantly higher rates of gross total resection (79% vs. 44%, p = 0.0008), shorter operative times (74 vs. 146 min, p < 0.0001), lower blood loss (119 vs. 284 cc, p < 0.0001), and hospital stays (2.9 vs. 4.2 days, p = 0.001). Overall complication rates were lower in the IOUS group compared to standard pituitary surgery but did not reach significance.
Recent improvements in ultrasound technology have allowed for miniaturization of probes capable of delivering high-resolution images. The use of IOUS in transsphenoidal pituitary surgery may significantly increase rates of gross total resection, while decreasing blood loss, hospital LOS, and operative time.
垂体手术的发展使其成为一种安全有效的治疗方法；然而，肿瘤切除不充分、脑脊液（CSF）漏、垂体功能障碍和血管损伤的风险仍然存在。术中超声（IOUS）在垂体手术中的应用已有很好的描述。这里描述了超声技术的最新进展，扩大了其应用范围。
回顾性分析 2016 年 1 月至 2019 年 12 月期间接受经蝶窦垂体肿瘤切除术的 138 例患者（平均年龄 53.7 岁，47%为女性）。34 例患者采用侧发射超声探头行 IOUS，104 例患者未行 IOUS。分析了术前（人口统计学、临床和影像学特征）、围手术期（出血量、手术时间）和术后（并发症、住院时间、激素缓解和肿瘤切除程度）的结果。
两组患者的年龄、性别、肿瘤体积、Knosp 分级和激素分泌状态无显著差异。使用 IOUS 治疗的患者肿瘤全切率明显更高（79% vs. 44%，p = 0.0008），手术时间更短（74 分钟 vs. 146 分钟，p < 0.0001），出血量更少（119 毫升 vs. 284 毫升，p < 0.0001），住院时间更短（2.9 天 vs. 4.2 天，p = 0.001）。IOUS 组的总体并发症发生率低于标准垂体手术组，但差异无统计学意义。
超声技术的最新进展使得能够提供高分辨率图像的探头小型化。在经蝶窦垂体手术中使用 IOUS 可能显著提高全切率，同时减少出血量、住院时间和手术时间。
