Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.
Department of Neurosurgery, The First People's Hospital of Changde, Changde, China.
Front Endocrinol (Lausanne). 2022 Apr 25;13:837025. doi: 10.3389/fendo.2022.837025. eCollection 2022.
To evaluate the long-term outcomes and safety of endoscopic transsphenoidal surgery (ETS) in recurrent and residual pituitary adenomas (rrPAs), as well as the predictors of gross total resection (GTR) and intraoperative CSF leakage. Furthermore, to compare outcomes and complications with non-rrPAs cohort.
Clinical and radiological characteristics of patients with rrPAs who underwent ETS were collected between 2017 and 2020. Data of patients with non-rrPAs were collected from 2019 to 2020. Logistic regression analyses were performed to investigate the factors influencing gross total resection (GTR) and intraoperative CSF leakage. Between-group comparisons of outcomes and complications were performed through propensity score analysis.
We enrolled 73 patients with rrPAs. GTR was achieved in 41 (56.1%) cases; further, GTR or near-total resection was achieved in 93.2% of patients. The mean tumor volumes for GTR and non-GTR cases were 6.2 ±7.2 cm and 11.1 ±9.1 cm, respectively. Multivariate regression analysis of the GTR rate in patients with rrPAs revealed that Knosp grade was an independent factor (odds ratio [OR] = 0.324; p=0.005). Moreover, previous transcranial surgery and non-functional pituitary adenomas were risk factors for intraoperative CSF leakage in patients with rrPAs (OR=6.450, p=0.019 and OR=7.472, p=0.012, respectively). After propensity score matching, There was no significant difference in the GTR rate between patients with rrPAs and patients with non-rrPAs. Contrastingly, patients with rrPAs had a higher rate of intraoperative CSF leakage and longer postoperative hospital stay than patients with non-rrPAs. During the follow-up, vision improved in 9 (22.0%) and 24 (62.5%) patients with rrPAs and non-rrPAs, respectively. Although there was a trend that reoperation of rrPAs involved a lower hypopituitarism recovery rate and biochemical remission rate, as well as a higher hypopituitarism rate, there was no statistically significant between-group difference.
Knosp grade was an independent factor for GTR in endoscopic transsphenoidal surgery in patients with rrPAs. Previous transcranial surgery and non-functional PAs were risk factors for intraoperative CSF leakage. Although associated with longer hospital stay, rrPAs did not associate with lower GTR rate or more frequent postoperative complications than non-rrPAs cohort.
评估内镜经蝶窦手术（ETS）治疗复发性和残留垂体腺瘤（rrPAs）的长期疗效和安全性，以及预测大体全切除（GTR）和术中脑脊液漏的因素。此外，与非 rrPAs 队列进行比较。
收集 2017 年至 2020 年期间接受 ETS 的 rrPAs 患者的临床和影像学特征。2019 年至 2020 年收集非 rrPAs 患者的数据。通过逻辑回归分析探讨影响 GTR 和术中脑脊液漏的因素。通过倾向评分分析比较两组之间的结局和并发症。
共纳入 73 例 rrPAs 患者。41 例（56.1%）达到 GTR；此外，93.2%的患者达到 GTR 或近全切除。GTR 组和非 GTR 组的平均肿瘤体积分别为 6.2±7.2cm 和 11.1±9.1cm。多因素回归分析显示 Knosp 分级是 rrPAs 患者 GTR 率的独立因素（比值比[OR]=0.324；p=0.005）。此外，既往经颅手术和无功能性垂体腺瘤是 rrPAs 患者术中脑脊液漏的危险因素（OR=6.450，p=0.019 和 OR=7.472，p=0.012）。经过倾向评分匹配后，rrPAs 患者和非 rrPAs 患者的 GTR 率无显著差异。相反，rrPAs 患者术中脑脊液漏发生率和术后住院时间均长于非 rrPAs 患者。在随访中，rrPAs 患者中有 9 例（22.0%）和 24 例（62.5%）视力改善，非 rrPAs 患者分别有 9 例（22.0%）和 24 例（62.5%）视力改善。虽然有趋势表明 rrPAs 的再次手术涉及较低的垂体功能减退恢复率和生化缓解率，以及较高的垂体功能减退发生率，但组间差异无统计学意义。
Knosp 分级是 rrPAs 患者内镜经蝶窦手术 GTR 的独立因素。既往经颅手术和无功能性 PAs 是术中脑脊液漏的危险因素。虽然 rrPAs 患者的住院时间较长，但与非 rrPAs 队列相比，GTR 率或术后并发症发生率并无降低。
