Selective resection of the medial wall of the cavernous sinus in pituitary surgery: results of a prospective single center analysis.

IF 3.3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Pituitary Pub Date : 2025-01-25 DOI:10.1007/s11102-024-01476-y

Dan Zimelewicz Oberman, Emiliano Sanchez-Garavito, Carlos Perez-Vega, Angela Donaldson, Osarenoma Olomu, Stephen Graepel, Mark A Edgar, Alfredo Quinones-Hinojosa, Kaisorn L Chaichana, Susan L Samson, Joao Paulo Almeida

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引用次数: 0

Abstract

Purpose: Pituitary adenomas, despite their histologically benign nature, can severely impact patients' quality of life due to hormone hypersecretion. Invasion of the medial wall of the cavernous sinus (MWCS) by these tumors complicates surgical outcomes, lowering biochemical remission rates and increasing recurrence. This study aims to share our institutional experience with the selective resection of the MWCS in endoscopic pituitary surgery.

Methods: This prospective study included patients diagnosed with pituitary adenomas who underwent endoscopic endonasal surgery at Mayo Clinic, Jacksonville. Inclusion criteria encompassed confirmed pituitary adenomas, selective MWCS resection, and availability of histopathological data. Patient demographics, tumor characteristics, surgical outcomes, and postoperative complications were analyzed using descriptive statistics.

Results: Twenty-six cases met the inclusion criteria. Functional adenomas and macroadenomas constituted 80.8% of cases. Recurrent adenomas represented 19.2% of cases. Tumor invasion of the MWCS was confirmed in 76.9% of cases and patients with acromegaly had the highest rate of confirmed invasion of the MW (88.8%). Initial disease control was achieved in 88.5% of the patients, and disease remission at last follow up was observed in those with acromegaly, Cushing's disease and prolactinomas in 87.5%, 83.3% and 66.6% of cases, respectively. Complete resection was achieved in 5/5 nonfunctioning adenomas. There were no carotid injuries, cranial deficits or fatalities observed.

Conclusion: Resection of the MWCS is an effective strategy for improving surgical outcomes in pituitary adenomas with potential invasion into this area, especially in patients with functional and/or recurrent adenomas. The procedure demonstrates a positive balance of efficacy and safety, when performed by teams with high level of experience in endoscopic skull base surgery and in selected patients.

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垂体手术中选择性切除海绵窦内侧壁：一项前瞻性单中心分析的结果。

目的：垂体腺瘤虽然在组织学上是良性的，但由于激素分泌过多，严重影响患者的生活质量。这些肿瘤侵入海绵窦内侧壁（MWCS）使手术结果复杂化，降低生化缓解率并增加复发率。本研究旨在分享我们在垂体内窥镜手术中选择性切除MWCS的经验。方法：这项前瞻性研究包括在杰克逊维尔梅奥诊所接受鼻内窥镜手术诊断为垂体腺瘤的患者。纳入标准包括确诊的垂体腺瘤，选择性MWCS切除术和组织病理学资料的可用性。采用描述性统计分析患者人口统计学、肿瘤特征、手术结果和术后并发症。结果：26例符合纳入标准。功能性腺瘤和大腺瘤占80.8%。复发性腺瘤占19.2%。76.9%的病例证实肿瘤侵犯MWCS，肢端肥大症患者的MWCS侵犯率最高（88.8%）。88.5%的患者获得初始疾病控制，87.5%的肢端肥大症患者、83.3%的库欣病患者和66.6%的催乳素瘤患者在最后随访中疾病缓解。5/5无功能腺瘤完全切除。没有观察到颈动脉损伤、颅骨缺损或死亡。结论：对于可能侵犯该区域的垂体腺瘤，尤其是功能性和/或复发性腺瘤，切除MWCS是改善手术效果的有效策略。当由具有高水平内窥镜颅底手术经验的团队和选定的患者进行手术时，该手术证明了疗效和安全性的积极平衡。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pituitary 医学-内分泌学与代谢

CiteScore

7.10

自引率

7.90%

发文量

审稿时长

6 months

期刊介绍： Pituitary is an international publication devoted to basic and clinical aspects of the pituitary gland. It is designed to publish original, high quality research in both basic and pituitary function as well as clinical pituitary disease. The journal considers: Biology of Pituitary Tumors Mechanisms of Pituitary Hormone Secretion Regulation of Pituitary Function Prospective Clinical Studies of Pituitary Disease Critical Basic and Clinical Reviews Pituitary is directed at basic investigators, physiologists, clinical adult and pediatric endocrinologists, neurosurgeons and reproductive endocrinologists interested in the broad field of the pituitary and its disorders. The Editorial Board has been drawn from international experts in basic and clinical endocrinology. The journal offers a rapid turnaround time for review of manuscripts, and the high standard of the journal is maintained by a selective peer-review process which aims to publish only the highest quality manuscripts. Pituitary will foster the publication of creative scholarship as it pertains to the pituitary and will provide a forum for basic scientists and clinicians to publish their high quality pituitary-related work.