Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
World Neurosurg. 2023 Jul;175:e832-e840. doi: 10.1016/j.wneu.2023.04.031. Epub 2023 Apr 14.
This study aimed to clarify the symptoms of pituitary or parasellar tumor onset with cranial nerve palsy (CNP) and to improve our knowledge of this rare symptom and its most appropriate treatment.
Among 1281 patients with pituitary or parasellar tumors surgically treated from 2003 to 2020, 30 cases (2.34%; 15 men and 15 women; mean age: 55.6 years, range: 6-83 years) first presenting with CNP were reviewed to evaluate the neurological symptoms, histological diagnosis, interval from onset to surgery, and time before complete CNP recovery.
Pathological diagnoses comprised 17 pituitary adenomas, including 10 pituitary apoplexies and 4 adrenocorticotropic hormone-positive adenomas, and 13 other tumors, including 3 chordomas, 2 xanthogranulomas, 2 malignant lymphomas, 2 metastatic tumors, 1 Rathke cleft cyst, 1 plasmacytoma, 1 craniopharyngioma, and 1 neuroendocrine carcinoma. The mechanisms causing CNP were pituitary apoplexy (n = 10), cranial nerve compression or involvement (n = 17), and inflammatory changes (n = 9). As the first manifestation, 20 (66.7%) patients presented with oculomotor nerve palsy, 2 (6.7%) with trochlear nerve palsy, and 13 (43.3%) with abducens nerve palsy. Full recovery of CNP was obtained in 25 patients (83.3%) after surgery alone and in 2 patients (6.7%) after adjuvant therapy. Early surgery provided no significant difference in full recovery rates although it reduced the time to reach full recovery.
It is critical to determine the mechanisms of CNP and intervene surgically to improve symptoms, shorten the duration of the disorder, prevent relapses, and obtain the correct pathological diagnosis to select the proper adjuvant therapy.
本研究旨在阐明伴颅神经麻痹（CNP）的垂体或鞍旁肿瘤发病症状，提高对这种罕见症状及其最佳治疗方法的认识。
在 2003 年至 2020 年间手术治疗的 1281 例垂体或鞍旁肿瘤患者中，回顾性分析了 30 例（2.34%；男 15 例，女 15 例；平均年龄：55.6 岁，范围：6-83 岁）以 CNP 为首发症状的患者，评估神经症状、组织学诊断、发病至手术的间隔时间以及 CNP 完全恢复前的时间。
病理诊断包括 17 例垂体腺瘤，其中 10 例为垂体卒中，4 例为促肾上腺皮质激素阳性腺瘤，13 例其他肿瘤，包括 3 例脊索瘤、2 例黄色肉芽肿、2 例恶性淋巴瘤、2 例转移瘤、1 例 Rathke 裂囊肿、1 例浆细胞瘤、1 例颅咽管瘤和 1 例神经内分泌癌。导致 CNP 的机制包括垂体卒中（n=10）、颅神经受压或受累（n=17）和炎症改变（n=9）。首发表现为动眼神经麻痹 20 例（66.7%），滑车神经麻痹 2 例（6.7%），展神经麻痹 13 例（43.3%）。单纯手术治疗 25 例（83.3%）患者 CNP 完全恢复，2 例（6.7%）患者辅助治疗后恢复。尽管早期手术可提高完全恢复率并缩短达到完全恢复的时间，但对完全恢复率无显著影响。
确定 CNP 的发病机制并进行手术干预以改善症状、缩短疾病持续时间、预防复发以及获得正确的病理诊断以选择适当的辅助治疗至关重要。
