Souter John Robert, Jusue-Torres Ignacio, Grahnke Kurt, Borys Ewa, Patel Chirag, Germanwala Anand V
Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois, United States.
Department of Pathology, Loyola University Stritch School of Medicine, Maywood, Illinois, United States.
J Neurol Surg B Skull Base. 2021 Apr;82(2):182-188. doi: 10.1055/s-0039-3400220. Epub 2019 Nov 11.
For patients presenting with neurological changes from pituitary tumor apoplexy, urgent surgical intervention is commonly performed for diagnosis, tumor resection, and optic apparatus decompression. Although identification and preservation of the pituitary gland during the time of surgery can be challenging, it may lead to improve endocrine outcomes. A retrospective case series of all patients with macroadenomas presenting with apoplexy at Loyola University Medical Center from 2016 to 2018 was studied. Demographic, radiographic, and intraoperative characteristics were collected including age, gender, comorbidities, presenting symptoms, preoperative size of pituitary adenoma, Knosp's grade, Hardy's grade, identification and/or preservation of the gland, pre- and postoperative hormonal levels, intraoperative and/or postoperative complications, and follow-up time. A total of 68 patients underwent endoscopic endonasal surgery for resection of a macroadenoma. Among them, seven (10.2%) presented with apoplexy; five patients were male and two were female and presenting symptoms and signs included headache (100%), endocrinopathies (57%), visual acuity deficit (71%), visual field deficit (71%), and oculomotor palsy (57%). A gross-total resection rate was achieved in 86% of patients. Among them, 71% of patients obtained complete symptomatic neurological improvement. A statistically significant difference between gender and endocrine function was found, as no females and all males required some form of postoperative hormonal supplementation ( = 0.047) Endoscopic endonasal resection of macroadenomas with sparing of the pituitary gland in the setting of apoplexy is safe and effective. Preservation of the normal gland led to no posterior pituitary dysfunction, and a statistically significant difference between gender and postoperative endocrinopathy was identified. Further studies with larger samples sizes are warranted.
对于因垂体瘤卒中出现神经功能改变的患者，通常会进行紧急手术干预，以进行诊断、肿瘤切除和视神经减压。尽管在手术过程中识别和保留垂体具有挑战性，但这可能会改善内分泌结局。 对2016年至2018年在洛约拉大学医学中心出现卒中的所有大腺瘤患者进行了一项回顾性病例系列研究。收集了人口统计学、影像学和术中特征，包括年龄、性别、合并症、临床表现、垂体腺瘤术前大小、克诺斯普分级、哈代分级、腺体的识别和/或保留、术前和术后激素水平、术中及/或术后并发症以及随访时间。 共有68例患者接受了内镜下经鼻手术切除大腺瘤。其中，7例（10.2%）出现卒中；5例为男性，2例为女性，临床表现和体征包括头痛（100%）、内分泌疾病（57%）、视力减退（71%）、视野缺损（71%）和动眼神经麻痹（57%）。86%的患者实现了全切除。其中，71%的患者神经症状完全改善。发现性别与内分泌功能之间存在统计学显著差异，因为没有女性需要术后激素补充，而所有男性都需要某种形式的术后激素补充（P = 0.047） 在内镜下经鼻切除卒中情况下的大腺瘤并保留垂体是安全有效的。保留正常腺体会导致无垂体后叶功能障碍，并且确定了性别与术后内分泌疾病之间存在统计学显著差异。有必要进行更大样本量的进一步研究。
