Liang Xiao, Li Zhuoqun, Xing Mengyang, Gao Wenbo, Liu Pengfei
Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, Shandong, China.
Front Surg. 2024 Dec 6;11:1439909. doi: 10.3389/fsurg.2024.1439909. eCollection 2024.
The surgical treatment of pituitary adenomas (PAs) is aimed at achieving maximal tumor resection, relieving the compression, and correcting the disorders of pituitary hormones. Parasellar dural invasion is a primary factor in the failure of the surgery. By comparing the two operations of tumor excision combined with resection of the medial wall of the cavernous sinus (MW) and simple tumor excision, we further confirmed the clinical effectiveness and safety of the resection technique of the MW.
41 patients with functional pituitary adenoma (FPA) were divided into two groups according to the operation. The experimental group consisted of 20 patients who underwent tumor excision combined with resection of the MW via endonasal transsphenoidal approach and 21 patients who underwent simple pituitary tumor excision as the control group. Both groups were followed up for 12 months and matched for age, sex, BMI, tumor type, Knosp grade, maximum tumor diameter, hypertension, diabetes, and coronary disease. Perioperative-related indicators, biochemical remission rates, tumor recurrence rates, and complications were assessed.
A total of 21 medial walls were removed in 20 patients, 15 (71%) specimens had pathologically confirmed tumor invasion. Biochemical remission rates and average operative duration in the experimental group were more than in the control group ( < 0.05). The remaining perioperative indicators, complications, and tumor recurrence rates had no statistically significant difference ( > 0.05).
The technique of the MW removal via endonasal transsphenoidal approach for FPAs is safe and effective, with a high biochemical remission. The average operative duration for MW removal may be longer than that for simple tumor excision.
垂体腺瘤（PAs）的外科治疗旨在实现肿瘤最大程度切除、缓解压迫并纠正垂体激素紊乱。鞍旁硬脑膜侵犯是手术失败的主要因素。通过比较肿瘤切除联合海绵窦内侧壁（MW）切除与单纯肿瘤切除这两种手术方式，我们进一步证实了MW切除技术的临床有效性和安全性。
41例功能性垂体腺瘤（FPA）患者根据手术方式分为两组。实验组20例患者经鼻蝶入路行肿瘤切除联合MW切除，21例患者行单纯垂体肿瘤切除作为对照组。两组均随访12个月，在年龄、性别、BMI、肿瘤类型、Knosp分级、肿瘤最大直径、高血压、糖尿病和冠心病方面进行匹配。评估围手术期相关指标、生化缓解率、肿瘤复发率及并发症。
20例患者共切除21个内侧壁，15个（71%）标本经病理证实有肿瘤侵犯。实验组的生化缓解率和平均手术时长均高于对照组（<0.05）。其余围手术期指标、并发症及肿瘤复发率无统计学差异（>0.05）。
经鼻蝶入路切除FPA的MW技术安全有效，生化缓解率高。切除MW的平均手术时长可能比单纯肿瘤切除的手术时长更长。
