Iwamura Haruka, Nonaka Masahiro, Li Yi, Ueno Katsuya, Takeda Junichi, Hashiba Tetsuo, Asai Akio
Department of Neurosurgery, Kansai Medical University, Hirakata, Japan.
Surg Neurol Int. 2023 Jan 27;14:30. doi: 10.25259/SNI_1060_2022. eCollection 2023.
A giant prolactinoma extending to the suprasellar area and causing hydrocephalus may be life-threatening and should be treated promptly. A case of a giant prolactinoma with acute hydrocephalus that underwent transventricular neuroendoscopic tumor resection followed by cabergoline administration is presented.
A 21-year-old man had a headache lasting for about a month. He gradually developed nausea and disturbance of consciousness. Magnetic resonance imaging showed a contrast-enhanced lesion that extended from the intrasellar space to the suprasellar space and into the third ventricle. The tumor obstructed the foramen of Monro and caused hydrocephalus. A blood test showed marked elevation of prolactin (16,790 ng/mL). The tumor was diagnosed as a prolactinoma. The tumor in the third ventricle had formed a cyst, and the cyst wall blocked the right foramen of Monro. The cystic component of the tumor was resected using an Olympus VEF-V flexible neuroendoscope. The histological diagnosis was pituitary adenoma. The hydrocephalus improved rapidly and his consciousness became clear. After the operation, he was started on cabergoline. The tumor size subsequently decreased.
Prompt partial resection of the giant prolactinoma by transventricular neuroendoscopy resulted in early improvement of hydrocephalus with less invasiveness, allowing subsequent treatment with cabergoline.
巨大催乳素瘤延伸至鞍上区域并导致脑积水可能危及生命，应及时治疗。本文报告一例巨大催乳素瘤合并急性脑积水患者，该患者接受了经脑室神经内镜肿瘤切除术，随后给予卡麦角林治疗。
一名21岁男性头痛持续约1个月。他逐渐出现恶心和意识障碍。磁共振成像显示一个强化病变，从鞍内延伸至鞍上并进入第三脑室。肿瘤阻塞了孟氏孔，导致脑积水。血液检查显示催乳素显著升高（16,790 ng/mL）。肿瘤被诊断为催乳素瘤。第三脑室内的肿瘤形成了一个囊肿，囊肿壁阻塞了右侧孟氏孔。使用奥林巴斯VEF-V软性神经内镜切除了肿瘤的囊性部分。组织学诊断为垂体腺瘤。脑积水迅速改善，他的意识变得清醒。术后，他开始服用卡麦角林。随后肿瘤体积缩小。
经脑室神经内镜对巨大催乳素瘤进行及时的部分切除，以较小的侵袭性使脑积水早期得到改善，从而允许后续使用卡麦角林进行治疗。
