USC Pituitary Center, Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
USC Pituitary Center, Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
World Neurosurg. 2021 Apr;148:e536-e546. doi: 10.1016/j.wneu.2021.01.018. Epub 2021 Jan 14.
The direct endoscopic endonasal approach (EEA) has become the primary technique used for resection of sellar pathology, meriting investigation into the risk factors for complications and predictors of postoperative outcomes after direct EEA.
We retrospectively analyzed the patient and tumor characteristics from 404 patients who had undergone direct EEA for sellar pathology at the USC Pituitary Center from September 2011 to December 2019.
Of the 404 pathologic entities included, 349 (86%) were pituitary adenomas (PAs), 29 (7%) were Rathke cleft cysts, and 26 (6%) were other sellar lesions. The mean lesion diameter was 2.3 cm, with 34 microadenomas (10%) and 315 macroadenomas (90%). Cavernous sinus invasion was present in 39% of the PAs. No patient died. The surgical complications included internal carotid artery injury without neurological sequelae (0.2%), vision loss (0.7%), meningitis (0.7%), cerebrospinal fluid leak (4%), epistaxis (4%), sinusitis (1%), transient cranial nerve paresis (0.5%), and postoperative abscess (0.25%). New hypopituitarism developed in 3%. Gross total resection was achieved in 208 PA cases (58%). Clinical improvement of headaches and visual deficits were reported for 67% and 76% of cases, respectively. Hormonal remission was achieved in 82% of patients with functional PAs. The median hospital stay was 2 days, with 34 patients (8%) readmitted within 30 days and 10 (3%) undergoing early reoperation. Disease recurrence or progression developed in 10% and was less likely in the case of gross total resection and apoplexy.
In the present, large, consecutive, mostly single-surgeon series, the patients experienced clinical improvement in most preoperative symptoms and had low rates of perioperative morbidity. We have demonstrated that direct EEA can be efficiently, safely, and successfully performed by a neurosurgical team.
直接经鼻内镜入路（EEA）已成为切除鞍区病变的主要技术，因此有必要研究其并发症的危险因素和直接 EEA 术后结果的预测因素。
我们回顾性分析了 2011 年 9 月至 2019 年 12 月期间，在南加州大学垂体中心接受直接 EEA 治疗的 404 例鞍区病变患者的患者和肿瘤特征。
在纳入的 404 种病变实体中，349 例（86%）为垂体腺瘤（PA），29 例（7%）为 Rathke 裂囊肿，26 例（6%）为其他鞍区病变。病变平均直径为 2.3cm，其中 34 例为微腺瘤（10%），315 例为大腺瘤（90%）。39%的 PA 存在海绵窦侵袭。无患者死亡。手术并发症包括无神经后遗症的颈内动脉损伤（0.2%）、视力丧失（0.7%）、脑膜炎（0.7%）、脑脊液漏（4%）、鼻出血（4%）、鼻窦炎（1%）、短暂性颅神经麻痹（0.5%）和术后脓肿（0.25%）。新发垂体功能减退症发生率为 3%。在 208 例 PA 病例中实现了大体全切除（58%）。分别有 67%和 76%的病例报告头痛和视力缺陷得到了临床改善。功能性 PA 患者的激素缓解率达到 82%。中位住院时间为 2 天，34 例（8%）在 30 天内再次入院，10 例（3%）行早期再次手术。10%的病例出现疾病复发或进展，而大体全切除和卒中的病例则不太可能出现这种情况。
在目前这项大规模、连续的、主要由单名外科医生进行的研究中，大多数患者的术前症状都得到了临床改善，且围手术期发病率较低。我们已经证明，直接 EEA 可以由神经外科团队高效、安全、成功地进行。
