Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Neuroendocrinology Unit, Division of Endocrinology and Metabolism, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Pituitary. 2022 Jun;25(3):508-519. doi: 10.1007/s11102-022-01221-3. Epub 2022 Apr 25.
To review our institutional experience with the surgical management of prolactinomas through the endoscopic endonasal approach with specific focus on cavernous sinus invasion.
Clinical and radiographic data were collected retrospectively from the electronic medical record of 78 consecutive patients with prolactinomas undergoing endoscopic endonasal resection from 2002 to 2019. Immediate and late post-operative remission were defined as prolactin < 20 ng/mL within 14 days and 1-year of surgery without adjuvant therapy, respectively. Cavernous sinus invasion was quantified by Knosp score.
A total of 78 patients with prolactinoma, 59% being male, underwent surgical resection with a mean age of 37 ± 13 years. Indications for surgery were medication resistance in 38 patients (48.7%), medication intolerance in 11 (14.1%), and patient preference in 29 (37.2%). Patients with Knosp 0-2 achieved higher immediate remission rates (83.8%) compared to patients with Knosp 3 (58.8%) and Knosp 4 (41.7%) patients (p = 0.003). Long-term remission rates were 48.7% and increased to 71.8% when combined with adjuvant treatments. Knosp 4 prolactinomas had significantly higher tumor volumes, higher preoperative prolactin levels, higher recurrence rates, higher rates of adjuvant therapy utilization, and were more likely to have failed dopamine agonist therapy compared to other tumor grades (p < 0.05). We encountered 18 complications in our series, and no cerebrospinal fluid leaks.
The endoscopic endonasal approach is a safe and effective modality that can be employed in properly selected patients with invasive prolactinomas. It is associated with improved control and remission rates despite cavernous sinus invasion, though at a lower rate than without invasion.
通过经鼻内镜手术治疗泌乳素瘤，探讨侵袭性海绵窦的手术治疗经验。
回顾性分析 2002 年至 2019 年间 78 例经鼻内镜下泌乳素瘤切除术患者的临床和影像学资料。术后 14 天内及 1 年内，催乳素<20ng/ml 且无需辅助治疗定义为即刻和晚期缓解。采用 Knosp 评分评估海绵窦侵袭程度。
共 78 例泌乳素瘤患者（59%为男性）接受手术治疗，平均年龄为 37±13 岁。手术指征为：38 例（48.7%）药物抵抗、11 例（14.1%）药物不耐受、29 例（37.2%）患者选择手术。Knosp 0-2 级患者即刻缓解率（83.8%）明显高于 Knosp 3 级（58.8%）和 Knosp 4 级（41.7%）患者（p=0.003）。联合辅助治疗后，长期缓解率为 48.7%，增至 71.8%。Knosp 4 级泌乳素瘤肿瘤体积更大，术前催乳素水平更高，复发率更高，辅助治疗使用率更高，且与其他肿瘤分级相比，多巴胺激动剂治疗失败的可能性更高（p<0.05）。本研究共发生 18 例并发症，无脑脊液漏。
经鼻内镜手术是一种安全有效的方法，可用于适当选择的侵袭性泌乳素瘤患者。尽管与海绵窦侵袭有关，但缓解率和控制率得到改善，尽管侵袭性海绵窦的缓解率低于无侵袭性海绵窦。
