Department Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Department of Head and Neck Cancer, Memorial Sloan Kettering Cancer Center, New York, USA.
Pituitary. 2023 Jun;26(3):293-297. doi: 10.1007/s11102-023-01318-3. Epub 2023 Apr 28.
Refractory pituitary adenomas are difficult to control tumors that progress through optimal surgical, medical, and radiation management. Repeat surgery is a valuable tool to reduce tumor volume for more effective radiation and/or medical therapy, and to decompress critical neurovascular structures. Advances in surgical techniques and technologies, including minimally invasive cranial approaches, intraoperative MRI suites, and cranial nerve monitoring, have improved surgical outcomes and expanded indications. Today, repeat transsphenoidal surgery has similar complications rates to upfront surgery in historical cohorts. The decision to operate on refractory adenomas should be made with multidisciplinary teams, balancing the benefit of tumor reduction with the potential for complications, including cranial nerve injury, carotid injury, and cerebrospinal fluid leak.
难治性垂体腺瘤是一种难以控制的肿瘤，即使经过最佳的手术、药物和放疗管理，仍会持续进展。再次手术是一种降低肿瘤体积的有效手段，有助于提高放疗和/或药物治疗的效果，并减轻对关键的颅神经和血管结构的压迫。手术技术和设备的进步，包括微创经颅入路、术中磁共振成像套件和颅神经监测等，都改善了手术结果并扩大了手术适应证。如今，重复经蝶窦手术与历史队列中初次手术的并发症发生率相似。对于难治性腺瘤，应与多学科团队共同决策是否手术，权衡肿瘤缩小的获益与潜在并发症的风险，包括颅神经损伤、颈动脉损伤和脑脊液漏等。
