The open sella technique for surgical treatment of pituitary macroadenomas: Safety and efficacy in a large clinical series.

IF 1 4区医学 Q4 CLINICAL NEUROLOGY

British Journal of Neurosurgery Pub Date : 2024-06-01 Epub Date: 2021-07-16 DOI:10.1080/02688697.2021.1950629

Pietro Mortini, Luigi Albano, Lina Raffaella Barzaghi, Alfio Spina, Marco Losa

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引用次数: 0

Abstract

Purpose: To analyse the efficacy and safety of the transsphenoidal microsurgical approach with open sella technique (OST) for the treatment of pituitary adenoma (PA) with suprasellar extension.

Methods: We retrospectively reviewed 2305 consecutive patients with PA who underwent their first surgery through the transsphenoidal microsurgical approach at our department between 1990 and 2018. Focusing on tumours with suprasellar extension, in particular, grade B, C and D adenomas according to Wilson-Hardy's classification, 376 patients who received the OST surgery were identified. Outcomes and complications were evaluated and compared with those obtained in patients who underwent a standard transsphenoidal approach (TSM).

Results: Two-hundred and sixty-four of 376 patients (70.2%) were found to be suffering from a non-functioning pituitary adenoma, whereas 112 of 376 patients (29.8%) from a hormone-secreting PA. The mean craniocaudal diameter of the tumor was 30.6 ± 0.3 mm (range, 21-75 mm) and 151 patients (40.1%) had a cavernous sinus invasion too. An overall surgical remission rate of 50.3% was achieved in the OST group, whereas the recurrence rate was 10.5%. Patients were followed for a mean period of 68 ± 1.4 months (range, 6-96 months). Less postoperative intrasellar haemorrhages have been recorded in the OST group than the TSM one (1.1% vs. 4.6%, p = 0.02).

Conclusions: In experienced hands, OST represents an effective and safe treatment strategy for PA with suprasellar extension.

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垂体大腺瘤手术治疗的开放蝶鞍技术：大型临床系列研究的安全性和有效性。

目的：分析经蝶显微外科手术方法与开放蝶鞍技术（OST）治疗星上扩展垂体腺瘤（PA）的有效性和安全性：我们回顾性研究了1990年至2018年期间在我科首次接受经蝶显微外科手术的2305例连续PA患者。根据威尔逊-哈代（Wilson-Hardy's）的分类，我们重点研究了有鞍上扩展的肿瘤，特别是 B、C 和 D 级腺瘤，确定了 376 名接受 OST 手术的患者。对手术效果和并发症进行了评估，并将其与接受标准经蝶窦方法（TSM）的患者进行了比较：结果：376 名患者中有 264 名（70.2%）患有无功能垂体腺瘤，而 376 名患者中有 112 名（29.8%）患有激素分泌型 PA。肿瘤的平均头尾直径为 30.6 ± 0.3 毫米（范围为 21-75 毫米），151 名患者（40.1%）的肿瘤还侵犯了海绵窦。OST 组的总体手术缓解率为 50.3%，而复发率为 10.5%。患者的平均随访时间为 68 ± 1.4 个月（6-96 个月）。OST组的术后腹腔内出血记录少于TSM组（1.1%对4.6%，P = 0.02）：结论：在经验丰富的医生手中，OST是一种有效且安全的治疗策略，适用于PA伴有髌上扩展的患者。

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

British Journal of Neurosurgery 医学-临床神经学

CiteScore

2.30

自引率

9.10%

发文量

139

审稿时长

3-8 weeks

期刊介绍： The British Journal of Neurosurgery is a leading international forum for debate in the field of neurosurgery, publishing original peer-reviewed articles of the highest quality, along with comment and correspondence on all topics of current interest to neurosurgeons worldwide. Coverage includes all aspects of case assessment and surgical practice, as well as wide-ranging research, with an emphasis on clinical rather than experimental material. Special emphasis is placed on postgraduate education with review articles on basic neurosciences and on the theory behind advances in techniques, investigation and clinical management. All papers are submitted to rigorous and independent peer-review, ensuring the journal’s wide citation and its appearance in the major abstracting and indexing services.