Symon L, Jakubowski J, Kendall B
J Neurol Neurosurg Psychiatry. 1979 Nov;42(11):973-82. doi: 10.1136/jnnp.42.11.973.
Multidirectional extension and invasive spread are important features of giant pituitary adenomas. Operability cannot be established merely by determining the size of the most prominent part of the tumour. Detailed radiological evaluation with plain films, computed tomography, angiography, and air studies all contribute to evaluation of the precise anatomy before surgery. In the final decision risks of surgical treatment must be balanced against the patient's age and prospects of long-term useful survival. Unfavourable cases for surgical treatment in our hands were those tumours embedded in the hypothalamus with thalamic and posterior extensions. Partial removal of such cases gave poor results. Where the mass proves soft, radical excision may be possible, but not otherwise. Limited biopsy for histological study, followed by a shunt procedure and x-ray therapy seems still the only recourse.
多向扩展和浸润性生长是巨大垂体腺瘤的重要特征。不能仅仅通过确定肿瘤最突出部分的大小来判断其可切除性。通过平片、计算机断层扫描、血管造影和空气造影等详细的放射学评估，都有助于术前对精确解剖结构的评估。在做出最终决定时，必须权衡手术治疗的风险与患者的年龄以及长期有效生存的前景。在我们的经验中，手术治疗的不利情况是那些嵌入下丘脑并伴有丘脑和后部扩展的肿瘤。对这类病例进行部分切除效果不佳。如果肿块质地柔软，可能可以进行根治性切除，否则不行。有限的组织学活检，随后进行分流手术和放疗似乎仍然是唯一的办法。
