Butterfield John T, Araki Takako, Guillaume Daniel, Tummala Ramachandra, Caicedo-Granados Emiro, Tyler Matthew A, Venteicher Andrew S
Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, United States.
Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, Minnesota, United States.
J Neurol Surg B Skull Base. 2021 Feb 22;83(Suppl 2):e152-e159. doi: 10.1055/s-0041-1722993. eCollection 2022 Jun.
Pituitary apoplexy after resection of giant pituitary adenomas is a rare but often cited morbidity associated with devastating outcomes. It presents as hemorrhage and/or infarction of residual tumor in the postoperative period. Because of its rarity, its incidence and consequences remain ill defined. The aim of this study is to estimate the rate of postoperative pituitary apoplexy after resection of giant pituitary adenomas and assess the morbidity and mortality associated with apoplexy. A systematic review of literature was performed to examine extent of resection in giant pituitary adenomas based on surgical approach, rate of postoperative apoplexy, morbidities, and mortality. Advantages and disadvantages of each approach were compared. Seventeen studies were included in quantitative analysis describing 1,031 cases of resection of giant pituitary adenomas. The overall rate of subtotal resection (<90%) for all surgical approaches combined was 35.6% (95% confidence interval: 28.0-43.1). Postoperative pituitary apoplexy developed in 5.65% ( = 19) of subtotal resections, often within 24 hours and with a mortality of 42.1% ( = 8). Resulting morbidities included visual deficits, altered consciousness, cranial nerve palsies, and convulsions. Postoperative pituitary apoplexy is uncommon but is associated with high rates of morbidity and mortality in subtotal resection cases. These findings highlight the importance in achieving a maximal resection in a time sensitive fashion to mitigate the severe consequences of postoperative apoplexy.
巨大垂体腺瘤切除术后垂体卒中是一种罕见但常被提及的并发症，其后果严重。它表现为术后残留肿瘤的出血和/或梗死。由于其罕见性，其发病率和后果仍不明确。
本研究的目的是估计巨大垂体腺瘤切除术后垂体卒中的发生率，并评估与垂体卒中相关的发病率和死亡率。
我们对文献进行了系统回顾，以研究基于手术方式的巨大垂体腺瘤切除范围、术后垂体卒中发生率、发病率和死亡率。比较了每种手术方式的优缺点。
定量分析纳入了17项研究，共描述了1031例巨大垂体腺瘤切除术病例。所有手术方式联合的次全切除率（<90%）为35.6%（95%置信区间：28.0-43.1）。次全切除病例中5.65%（n = 19）发生术后垂体卒中，通常在24小时内，死亡率为42.1%（n = 8）。由此导致的并发症包括视力缺陷、意识改变、颅神经麻痹和惊厥。
术后垂体卒中并不常见，但在次全切除病例中与高发病率和死亡率相关。这些发现凸显了在时间敏感的情况下实现最大程度切除以减轻术后垂体卒中严重后果的重要性。
