Pei Zhijie, Wang Jiaxing, Mu Shuwen, Feng Tianshun, Wang Meina, Yu Shentong, Wei Liangfeng, Fang Yi, Wang Shousen
Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China.
Department of Neurosurgery, The First Hospital of Yichang, The People's Hospital of China Three Gorges University, Yichang, China.
Front Neurol. 2022 May 27;13:880732. doi: 10.3389/fneur.2022.880732. eCollection 2022.
To analyze the risk factors affecting the gross-total resection of giant pituitary adenomas using a transsphenoidal approach under a microscope to provide a reference basis for formulating an appropriate surgical strategy.
The clinical data of patients who underwent microscopic transsphenoidal resection of giant pituitary adenomas in a single center from January 2011 to December 2020 were retrospectively analyzed. Based on magnetic resonance imaging and surgical records, the predictive factors affecting the gross-total resection of giant pituitary adenomas under microscopy were determined through univariate and multivariate analyses.
A total of 73 patients with giant pituitary adenomas underwent transsphenoidal microsurgery. Gross-total resection was performed in 19 cases (26%), subtotal resection in 31 cases (42%), partial resection in 21 cases (29%), and the degree of resection was <50% in only two cases (3%). After binary logistic analysis, it was found that it was more difficult to completely remove giant pituitary adenomas with a Knosp grade 3-4 [odds ratio (OR) = 0.214, 95% confidence interval (CI): 0.05-0.917; = 0.038], greater proportion of tumor suprasellar volume (odds ratio = 0.937, 95% confidence interval: 0.898-0.978; = 0.003), and intraoperative evidence of invasion of the cavernous sinus (odds ratio = 0.187, 95% CI: 0.039-0.898; = 0.036).
It is difficult to remove a giant pituitary adenoma invading the cavernous sinus completely with a higher degree of invasion of the suprasellar region using microscopic transsphenoidal surgery. The combined application of multiple surgical methods can help to improve the degree of resection during a single operation.
分析显微镜下经蝶入路切除巨大垂体腺瘤全切除的危险因素，为制定合适的手术策略提供参考依据。
回顾性分析2011年1月至2020年12月在单中心接受显微镜下经蝶窦切除巨大垂体腺瘤患者的临床资料。基于磁共振成像和手术记录，通过单因素和多因素分析确定影响显微镜下巨大垂体腺瘤全切除的预测因素。
共有73例巨大垂体腺瘤患者接受经蝶窦显微手术。19例（26%）行全切除，31例（42%）行次全切除，21例（29%）行部分切除，仅2例（3%）切除程度<50%。二元逻辑回归分析后发现，Knosp 3-4级的巨大垂体腺瘤更难完全切除[比值比（OR）=0.214，95%置信区间（CI）：0.05-0.917；P=0.038]，肿瘤鞍上体积占比更大（比值比=0.937，95%置信区间：0.898-0.978；P=0.003），以及术中存在海绵窦侵犯证据（比值比=0.187，95%CI：0.039-0.898；P=0.036）。
对于侵犯海绵窦且鞍上区域侵犯程度较高的巨大垂体腺瘤，显微镜下经蝶窦手术难以完全切除。多种手术方法联合应用有助于提高单次手术的切除程度。
