垂体腺瘤常侵入海绵窦(CS)的内壁,但由于血管和颅神经损伤的风险,这种结构通常不会手术切除。这项研究的目的是报告一系列侵袭性垂体腺瘤的手术结果,其中在解剖学基础上选择性地去除CS的内壁,逐步手术技术。
作者对机构数据库进行了审查,以确定孤立地侵犯内侧壁的垂体腺瘤病例,根据术中评估,其中患者接受内镜经鼻入路选择性切除CS内壁。排除CS侵犯超过内壁的病例。患者并发症,切除,并评估缓解率。
50名患者有资格参加这项研究,15(30%)患有非功能性腺瘤,35(70%)患有功能性腺瘤,包括16种生长激素,10催乳素-,和9个促肾上腺皮质激素(ACTH)分泌肿瘤。非功能性腺瘤的平均肿瘤大小为2.3cm,功能性腺瘤的平均肿瘤大小为1.3cm。射线照相,11例(22%)为Knosp1级,23例(46%)为Knosp2级,16例(32%)为Knosp3级。肿瘤完全切除,根据术中印象和术后MRI,在所有情况下都实现了。功能性腺瘤患者的平均随访时间为30个月(4-64个月),非功能性腺瘤患者的平均随访时间为16个月(4-30个月)。在最后的随访中,在34例(97%)功能性腺瘤中,未进行辅助治疗的生化完全缓解(使用当前标准).无功能性腺瘤患者未见影像学复发。50例患者共切除了57例内侧壁。在组织学上证实了93%的非功能性腺瘤和83%的功能性腺瘤中的内壁浸润。没有死亡或颈内动脉损伤,平均失血量为378ml。四名患者(8%)发展了一种新的,短暂性颅神经麻痹,其中2例患者需要再次手术以清除血凝块和去除脂肪移植物。没有永久性颅神经麻痹。
可以安全有效地去除CS的内壁,最低的发病率和优良的切除和缓解率。需要进一步的随访以确定这种基于解剖学的技术的长期结果,这只能由非常有经验的鼻内颅底团队进行。
Pituitary adenomas often invade the medial wall of the cavernous sinus (CS), but this structure is generally not surgically removed because of the risk of vascular and cranial nerve injury. The purpose of this study was to report the surgical outcomes in a large series of cases of invasive pituitary adenoma in which the medial wall of the CS was selectively removed following an anatomically based, stepwise surgical technique.
The authors\' institutional database was reviewed to identify cases of pituitary adenoma with isolated invasion of the medial wall, based on an intraoperative evaluation, in which patients underwent an endoscopic endonasal approach with selective resection of the medial wall of the CS. Cases with CS invasion beyond the medial wall were excluded. Patient complications, resection, and remission rates were assessed.
Fifty patients were eligible for this study, 15 (30%) with nonfunctional adenomas and 35 (70%) with functional adenomas, including 16 growth hormone-, 10 prolactin-, and 9 adrenocorticotropic hormone (ACTH)-secreting tumors. The average tumor size was 2.3 cm for nonfunctional and 1.3 cm for functional adenomas. Radiographically, 11 cases (22%) were Knosp grade 1, 23 (46%) Knosp grade 2, and 16 (32%) Knosp grade 3. Complete tumor resection, based on intraoperative impression and postoperative MRI, was achieved in all cases. The mean follow-up was 30 months (range 4-64 months) for patients with functional adenomas and 16 months (range 4-30 months) for those with nonfunctional adenomas. At last follow-up, complete biochemical remission (using current criteria) without adjuvant treatment was seen in 34 cases (97%) of functional adenoma. No imaging recurrences were seen in patients who had nonfunctional adenomas. A total of 57 medial walls were removed in 50 patients. Medial wall invasion was histologically confirmed in 93% of nonfunctional adenomas and 83% of functional adenomas. There were no deaths or internal carotid artery injuries, and the average blood loss was 378 ml. Four patients (8%) developed a new, transient cranial nerve palsy, and 2 of these patients required reoperation for blood clot evacuation and fat graft removal. There were no permanent cranial nerve palsies.
The medial wall of the CS can be removed safely and effectively, with minimal morbidity and excellent resection and remission rates. Further follow-up is needed to determine the long-term results of this anatomically based technique, which should only be performed by very experienced endonasal skull base teams.