Bajagain Madan, Fujio Shingo, Kirishima Mari, Yatsushiro Kazutaka, Hanaya Ryosuke
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, JPN.
Department of Pathology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, JPN.
Cureus. 2024 Mar 15;16(3):e56228. doi: 10.7759/cureus.56228. eCollection 2024 Mar.
Sellar paraganglioma (SP) is a rare benign tumor, usually treated by surgery. SPs are lobulated, firm, adherent, and highly vascular, allowing mostly partial resection. We present the case of a 52-year-old man diagnosed with primary SP, treated with a transcranial-transsphenoidal (TC-TS) surgical approach, followed by adjuvant Gamma Knife stereotactic radiosurgery (GKSR). The tumor has an extra-pituitary origin, with a sellar-suprasellar, right cavernous sinus extension that encroached the bilateral optic nerve and anterior cerebral artery. Histopathology confirmed SP with a Zellballen pattern. Despite postoperative tumor growth observed at four and 10 months, a stable residual tumor was noted at a follow-up two years after GKSR. SP is diagnosed mainly in middle age or in adolescent males. The TC-TS approach offers a bidirectional view that allows greater resection by minimizing blind spots, thus reducing complications. Similar to the paragangliomas of other sites, the efficacy of GKSR was observed for primary SP. SP is a rare differential diagnosis of pituitary diseases; however, it should be considered. After surgical resection of primary SP, GKSR is observed as an effective adjuvant therapy.
鞍旁副神经节瘤（SP）是一种罕见的良性肿瘤，通常采用手术治疗。SP呈分叶状、质地坚硬、粘连且血管丰富，大多只能进行部分切除。我们报告一例52岁男性原发性SP患者，采用经颅-经蝶窦（TC-TS）手术入路治疗，随后进行辅助伽玛刀立体定向放射外科治疗（GKSR）。肿瘤起源于垂体外，向鞍上及右侧海绵窦延伸，侵犯双侧视神经和大脑前动脉。组织病理学证实为具有Zellballen模式的SP。尽管在术后4个月和10个月观察到肿瘤生长，但在GKSR后两年的随访中发现残留肿瘤稳定。SP主要在中年或青少年男性中被诊断出来。TC-TS入路提供了双向视野，通过最小化盲点实现更大范围的切除，从而减少并发症。与其他部位的副神经节瘤类似，GKSR对原发性SP也有疗效。SP是垂体疾病罕见的鉴别诊断；然而，应予以考虑。原发性SP手术切除后，GKSR被视为一种有效的辅助治疗方法。
