Mason R B, Nieman L K, Doppman J L, Oldfield E H
Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA.
J Neurosurg. 1997 Sep;87(3):343-51. doi: 10.3171/jns.1997.87.3.0343.
When the surgeon identifies an adenoma within the gland and selectively excises it, endocrine-active pituitary tumors are usually cured and pituitary function is preserved. Occasionally ectopic adenomas arise primarily in the pituitary stalk or arise superiorly in the midportion of the anterior lobe and extend upward within the stalk. To determine if these tumors can be selectively excised with preservation of pituitary function, the authors examined the outcome of selective adenomectomy in 10 patients with Cushing's disease with an ectopic adenoma originating in, and confined to, the stalk (four microadenomas) or an adenoma extending superiorly through the diaphragma sella and into the stalk (five microadenomas and one macroadenoma) from an operative series of 516 patients with Cushing's disease. To reach the adenoma transsphenoidally in these patients, the diaphragma sella was incised anteroposteriorly in the midline to the anterior edge of the stalk, the suprasellar cistern was entered, and the adenoma was selectively excised using care to limit injury to the infundibulum. After selective adenomectomy, Cushing's disease remitted in all patients. All patients were hypocortisolemic immediately after surgery and required hydrocortisone for up to 21 months. Apart from the adrenal axis, pituitary function was normal in five patients in the immediate postoperative period, including two patients with tumors confined to the stalk and three patients with preoperative hypothyroidism (one patient) and/or hypogonadism (three patients). Three others with transient postoperative hypothyroidism (one patient) or diabetes insipidus (two patients) had normal pituitary function within 7 months of surgery. One patient with hypothyroidism and one with hypogonadism before surgery had panhypopituitarism postoperatively. A patient with a microadenoma located high in the stalk next to the optic chiasm had bitemporal hemianopsia postoperatively. These results demonstrate the feasibility of achieving curative transsphenoidal resection and preservation of pituitary function in cases of pituitary adenomas that are confined to the pituitary stalk or tumors that extend superiorly within the stalk from an intrasellar origin.
当外科医生在腺体内识别出腺瘤并进行选择性切除时，内分泌活性垂体肿瘤通常可治愈且垂体功能得以保留。偶尔，异位腺瘤主要起源于垂体柄，或起源于前叶中部上方并在柄内向上延伸。为了确定这些肿瘤能否在保留垂体功能的情况下进行选择性切除，作者从516例库欣病患者的手术系列中，研究了10例起源于并局限于垂体柄的异位腺瘤（4例微腺瘤）或向上延伸穿过鞍隔进入垂体柄的腺瘤（5例微腺瘤和1例大腺瘤）患者进行选择性腺瘤切除术的结果。为经蝶窦到达这些患者的腺瘤，在中线处从前向后切开鞍隔至垂体柄前缘，进入鞍上池，小心地选择性切除腺瘤，以限制对漏斗的损伤。选择性腺瘤切除术后，所有患者的库欣病均缓解。所有患者术后立即出现皮质醇减少，需要氢化可的松治疗长达21个月。除肾上腺轴外，5例患者术后即刻垂体功能正常，包括2例肿瘤局限于垂体柄的患者以及3例术前有甲状腺功能减退（1例患者）和/或性腺功能减退（3例患者）的患者。另外3例术后出现短暂甲状腺功能减退（1例患者）或尿崩症（2例患者）的患者在术后7个月内垂体功能恢复正常。1例术前有甲状腺功能减退的患者和1例术前有性腺功能减退的患者术后出现全垂体功能减退。1例位于垂体柄高位靠近视交叉处的微腺瘤患者术后出现双颞侧偏盲。这些结果表明，对于局限于垂体柄的垂体腺瘤或起源于鞍内并在柄内向上延伸的肿瘤，经蝶窦实现根治性切除并保留垂体功能是可行的。
