Department of Neurological Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
Department of Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
World Neurosurg. 2024 Apr;184:e659-e673. doi: 10.1016/j.wneu.2024.02.009. Epub 2024 Feb 9.
Giant pituitary adenomas (GPAs) are defined as tumors with ≥40 mm in any maximum diameter, and these tend to invade multiple intracranial compartments. Hence, treatment remains a surgical challenge.
To describe the clinical and surgical outcomes of the endoscopic endonasal approach (EEA) for GPA in a pituitary referral center in Latin America and to analyze associated predictive factors.
37 patients with histologically-confirmed GPA treated solely through the EEA between a 2-year period were included. Preoperative and postoperative clinical and neuroimaging findings; surgical morbidity and mortality; and binary logistic regression analysis to assess predictive factors were analyzed.
Preoperative visual impairment prevalence was 97.3%. Mean tumor volume was 32 cc and gross total resection rate was 40.5%. Favorable visual acuity and visual fields outcome rate was 75% and 82.9%, respectively. In the multivariate analysis, bilateral cavernous sinus invasion (P = 0.018) and postoperative cerebrospinal fluid (CSF) leak (P = 0.036) were associated with an unfavorable visual acuity outcome, while radiation therapy (P = 0.035) was for visual fields. Similarly, intraoperative CSF leak was a predictive factor for postoperative CSF leak (10.8%) (P = 0.042) and vascular injury (13.5%) (P = 0.048).
In this first Mexican clinical series, we demonstrated that the EEA is a safe and effective technique for GPA, although early diagnosis and prompt intervention may promote further visual function preservation without significant endocrine morbidity.
巨大垂体腺瘤（GPAs）被定义为任何最大直径≥40mm 的肿瘤，这些肿瘤往往会侵犯多个颅内隔室。因此，治疗仍然是一个手术挑战。
描述拉丁美洲一家垂体瘤转诊中心内镜经鼻入路（EEA）治疗 GPA 的临床和手术结果，并分析相关的预测因素。
纳入了 37 例在 2 年内仅通过 EEA 治疗的组织学证实的 GPA 患者。分析了术前和术后的临床和神经影像学发现、手术发病率和死亡率，以及二元逻辑回归分析来评估预测因素。
术前视力障碍的患病率为 97.3%。平均肿瘤体积为 32cc，全切除率为 40.5%。视力和视野的良好结局率分别为 75%和 82.9%。在多变量分析中，双侧海绵窦侵犯（P=0.018）和术后脑脊液（CSF）漏（P=0.036）与视力不良结局相关，而放射治疗（P=0.035）与视野相关。同样，术中 CSF 漏是术后 CSF 漏（10.8%）（P=0.042）和血管损伤（13.5%）（P=0.048）的预测因素。
在这项首次的墨西哥临床系列研究中，我们证明了 EEA 是治疗 GPA 的一种安全有效的技术，尽管早期诊断和及时干预可能会促进进一步的视力功能保留，而不会导致明显的内分泌发病率。
