PDF(Pubmed)
Abstract：
UNASSIGNED: Growth hormone (GH)--secreting pituitary adenomas can be aggressive and difficult to manage. Surgical resection for GH-secreting tumors remains the gold standard with increasing use of expanded endoscopic endonasal (EEA) techniques. Certain anatomical considerations make postsurgical biochemical remission challenging.
UNASSIGNED: We describe the case of a 43-year-old male presenting with acromegaly after a lack of biochemical remission from a previous surgery. Resection of the residual tumor invading the retrogenu compartment of the cavernous sinus was challenging for several reasons: (a) its location adjacent to the right parasellar horizontal internal carotid artery (ICA) with involvement of the medial wall, (b) the large kissing bilateral ICAs reducing the intercarotid distance, and (c) potential scar tissue. EEA was undertaken with key surgical steps, including wide bilateral sphenoidotomies, right middle clinoidectomy to access the clinoidal ICA and the retrogenu compartment, identification of the top of the paraclival ICA by drilling across the sella floor, division of the sellar floor dura to increase the intercarotid distance and transcavernous mobilization of medial wall, and the tumor capsule away from the horizontal parasellar ICA and across to the diaphragm and pituitary gland. Postoperatively, biochemical remission was achieved with no new endocrine deficits.
UNASSIGNED: These surgical nuances permit biochemical remission in complex revisional cases with acromegaly.
UNASSIGNED: We describe the case of a 43-year-old male presenting with acromegaly after a lack of biochemical remission from a previous surgery. Resection of the residual tumor invading the retrogenu compartment of the cavernous sinus was challenging for several reasons: (a) its location adjacent to the right parasellar horizontal internal carotid artery (ICA) with involvement of the medial wall, (b) the large kissing bilateral ICAs reducing the intercarotid distance, and (c) potential scar tissue. EEA was undertaken with key surgical steps, including wide bilateral sphenoidotomies, right middle clinoidectomy to access the clinoidal ICA and the retrogenu compartment, identification of the top of the paraclival ICA by drilling across the sella floor, division of the sellar floor dura to increase the intercarotid distance and transcavernous mobilization of medial wall, and the tumor capsule away from the horizontal parasellar ICA and across to the diaphragm and pituitary gland. Postoperatively, biochemical remission was achieved with no new endocrine deficits.
UNASSIGNED: These surgical nuances permit biochemical remission in complex revisional cases with acromegaly.
摘要：
■分泌生长激素（GH）的垂体腺瘤可能具有侵袭性，难以控制。随着越来越多地使用扩大的内镜鼻内（EEA）技术，GH分泌肿瘤的手术切除仍然是金标准。某些解剖学考虑使术后生化缓解具有挑战性。
■我们描述了一名43岁男性在先前手术缺乏生化缓解后出现肢端肥大症的情况。切除侵入海绵窦逆行区室的残留肿瘤具有挑战性，原因有几个：（a）其位置与右脑旁水平颈内动脉（ICA）相邻，并累及内侧壁，(b)大的接吻双侧ICA减少了颈动脉间的距离，和(c)潜在的瘢痕组织。EEA采用了关键的手术步骤，包括广泛的双侧蝶骨切开术，右中段临床切除术，以进入临床ICA和逆行室，通过在蝶鞍地板上钻孔来识别近旁ICA的顶部，分隔鞍底硬脑膜以增加颈动脉间距离和内侧壁的经海绵体动员，肿瘤囊远离水平的鞍旁ICA，并穿过diaphragm膜和垂体。术后,在没有新的内分泌缺陷的情况下实现了生化缓解.
■这些手术细微差别允许在复杂的肢端肥大症病例中进行生化缓解。
■我们描述了一名43岁男性在先前手术缺乏生化缓解后出现肢端肥大症的情况。切除侵入海绵窦逆行区室的残留肿瘤具有挑战性，原因有几个：（a）其位置与右脑旁水平颈内动脉（ICA）相邻，并累及内侧壁，(b)大的接吻双侧ICA减少了颈动脉间的距离，和(c)潜在的瘢痕组织。EEA采用了关键的手术步骤，包括广泛的双侧蝶骨切开术，右中段临床切除术，以进入临床ICA和逆行室，通过在蝶鞍地板上钻孔来识别近旁ICA的顶部，分隔鞍底硬脑膜以增加颈动脉间距离和内侧壁的经海绵体动员，肿瘤囊远离水平的鞍旁ICA，并穿过diaphragm膜和垂体。术后,在没有新的内分泌缺陷的情况下实现了生化缓解.
■这些手术细微差别允许在复杂的肢端肥大症病例中进行生化缓解。
