Takakura K, Teramoto A
Department of Neurosurgery, Tokyo Women's Medical College, Japan.
Acta Neurochir Suppl. 1996;65:13-5. doi: 10.1007/978-3-7091-9450-8_5.
Management of huge pituitary adenoma (more than 5 cm in diameter) is one of the most important issues on the treatment of pituitary tumors. We have analyzed the therapeutic modality and the result of our cases. From 1967 to 1983, 50 patients with huge adenoma (14.1%) out of a total 354 pituitary adenomas were surgically treated. The operative mortality was 25% for radical transcranial (TC) approach (10/40), 14% (1/7) for transsphenoidal (TS) approach and 0% (0/3) for combined two stage operations. From long-term follow-up, excellent prognoses were observed in only 44% of the patients treated by radical TC operation. After 1984, we have employed partial removal by TS surgery at the first stage, followed by reoperation by TS or TC surgery with or without radiotherapy or bromocriptine in case by case. Seventeen huge pituitary adenomas out of a total 700 pituitary adenomas were operated. There was no mortality nor major complications. The two stage operation with initial TS surgery is recommended for the management of huge pituitary adenomas.
巨大垂体腺瘤（直径超过5厘米）的治疗是垂体肿瘤治疗中最重要的问题之一。我们分析了我们病例的治疗方式和结果。1967年至1983年，在总共354例垂体腺瘤中，有50例巨大腺瘤（占14.1%）接受了手术治疗。经颅根治性手术（TC）的手术死亡率为25%（10/40），经蝶窦手术（TS）为14%（1/7），两阶段联合手术为0%（0/3）。从长期随访来看，经颅根治性手术治疗的患者中只有44%预后良好。1984年以后，我们采用第一阶段经蝶窦手术部分切除，然后根据具体情况，对部分患者进行经蝶窦或经颅再次手术，并结合放疗或溴隐亭治疗。在总共700例垂体腺瘤中，有17例巨大垂体腺瘤接受了手术。无死亡病例及严重并发症。对于巨大垂体腺瘤的治疗，建议采用以经蝶窦手术开始的两阶段手术。
