Sasaki Hiroo, Takeuchi Kazuhito, Nagata Yuichi, Tanahashi Kuniaki, Mizuno Akihiro, Harada Hideyuki, Kishida Yugo, Watanabe Tadashi, Nagatani Tetsuya, Saito Ryuta
Department of Neurosurgery, Nagoya University, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, Japan.
Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Acta Neurochir (Wien). 2023 Mar;165(3):667-675. doi: 10.1007/s00701-022-05415-3. Epub 2022 Nov 10.
Postoperative pituitary dysfunction, a critical problem in the treatment of craniopharyngiomas, can occur even when the pituitary stalk is preserved. We hypothesized that compromise of the primary superior hypophyseal artery (pSHA) might be related to this occurrence.
We performed a retrospective review of 131 patients with craniopharyngioma who underwent surgery from April 2009 to September 2021. The inclusion criteria were initial surgery, endoscopic transsphenoidal surgery, preoperative normal pituitary function or pituitary dysfunction in one axis, and morphological preservation of the pituitary stalk. The branches of the pSHA consist mainly of the chiasmatic branches (Cb), infundibular branches (Ib), and descending branches (Db). We analyzed the association between postoperative pituitary function and preservation of these branches.
Twenty patients met the criteria. Preoperative anterior pituitary function was normal in 18 patients, and there was isolated growth hormone deficiency in two patients. No patient had preoperative diabetes insipidus (DI). Anterior pituitary function was unchanged postoperatively in eight patients. Of these eight patients, bilateral preservation of pSHA Ib was confirmed in seven patients. Bilateral preservation of pSHA Ib was the only factor associated with preserved anterior pituitary function (p < 0.01). Fifteen patients were free of permanent DI, and the preservation of any given pSHA branch produced no significant difference in the postoperative occurrence of permanent DI.
Our study shows that bilateral preservation of pSHA Ib provides favorable postoperative anterior pituitary function in craniopharyngioma surgery; however, such preservation may have little effect on the postoperative occurrence of DI.
术后垂体功能障碍是颅咽管瘤治疗中的一个关键问题，即使垂体柄得以保留也可能发生。我们推测原发性垂体上动脉（pSHA）受损可能与此现象有关。
我们对2009年4月至2021年9月期间接受手术的131例颅咽管瘤患者进行了回顾性研究。纳入标准为初次手术、内镜经蝶窦手术、术前垂体功能正常或单轴垂体功能障碍，以及垂体柄形态学保留。pSHA的分支主要由视交叉分支（Cb）、漏斗分支（Ib）和下行分支（Db）组成。我们分析了术后垂体功能与这些分支保留之间的关联。
20例患者符合标准。18例患者术前垂体前叶功能正常，2例患者存在孤立性生长激素缺乏。无患者术前患有尿崩症（DI）。8例患者术后垂体前叶功能未改变。在这8例患者中，7例患者pSHA Ib双侧得以保留。pSHA Ib双侧保留是与垂体前叶功能保留相关的唯一因素（p < 0.01）。15例患者无永久性DI，任何给定pSHA分支的保留在术后永久性DI的发生方面无显著差异。
我们的研究表明，在颅咽管瘤手术中，pSHA Ib双侧保留可提供良好的术后垂体前叶功能；然而，这种保留对术后DI的发生可能影响不大。
