Department of Neurosurgery, Baku Medical Plaza, Baku, Azerbaijan.
Department of Neurosurgery, Baku Medical Plaza, Baku, Azerbaijan.
World Neurosurg. 2021 May;149:e1043-e1055. doi: 10.1016/j.wneu.2021.01.019. Epub 2021 Jan 29.
To present the outcomes of endoscopic endonasal surgery for giant pituitary adenomas and discuss the extent of resection to minimize morbidity and mortality.
We retrospectively reviewed medical records of 44 patients with giant pituitary adenomas who underwent endoscopic endonasal surgery. Clinical presentation, laboratory results, imaging studies, clinical outcomes, extent of resection, and complications were collected and analyzed. Factors affecting long-term outcome according to surgical technique were identified and analyzed.
Radical resection (RR) was defined as either gross total resection or near-total resection (90%-100% of the tumor). There were 28 patients (63.6%) who underwent RR, 10 patients (22.7%) who underwent subtotal resection, and 6 patients (13.6%) who underwent partial resection. Visual improvement was achieved in 27 patients (81.8%). Thirteen patients (72.2%) with pituitary dysfunction had improvement in at least 1 preoperative endocrinological dysfunction. RR rates for dumbbell and multilobular tumors were 44.4% and 28.6%, respectively. Surgical complications were observed in 14 (31.8%) patients. Major vascular injury occurred in 3 patients (6.8%). Mean follow-up period was 38.5 months (range, 1-70 months). No patients with RR had recurrence or residual tumor progression. Ten patients (22.7%) received adjuvant radiation therapy after resection. Two patients were reoperated on for tumor regrowth, and 3 patients (including the 2 patients with tumor regrowth) were lost to follow-up.
Long-term follow-up results and low recurrence rate of tumors indicate that RR is effective to decrease morbidity and mortality.
介绍经鼻内镜手术治疗巨大垂体腺瘤的结果，并探讨最大限度减少发病率和死亡率的切除范围。
我们回顾性分析了 44 例经鼻内镜手术治疗的巨大垂体腺瘤患者的病历。收集并分析了临床表现、实验室结果、影像学研究、临床结果、切除范围和并发症。根据手术技术确定并分析了影响长期结果的因素。
根治性切除（RR）定义为大体全切除或近全切除（肿瘤的 90%-100%）。28 例（63.6%）患者行 RR，10 例（22.7%）患者行次全切除，6 例（13.6%）患者行部分切除。27 例（81.8%）患者视力改善。13 例（72.2%）有垂体功能障碍的患者至少有 1 项术前内分泌功能障碍得到改善。哑铃型和多叶型肿瘤的 RR 率分别为 44.4%和 28.6%。14 例（31.8%）患者出现手术并发症。3 例（6.8%）患者发生大血管损伤。平均随访时间为 38.5 个月（1-70 个月）。RR 患者无肿瘤复发或残留肿瘤进展。10 例患者（22.7%）在切除后接受辅助放疗。2 例患者因肿瘤复发再次手术，3 例患者（包括 2 例肿瘤复发患者）失访。
长期随访结果和低肿瘤复发率表明，RR 可有效降低发病率和死亡率。
