INC美国William T Couldwell教授：经蝶入路显微手术切除小儿垂体腺瘤

　　Abstract

　　Objective:Pituitary adenomas are uncommon in the pediatric population. Although medical treatment can be effective in treating prolactinomas and some growth hormone-secreting tumors, resection is indicated in the setting of pituitary apoplexy, large or giant pituitary adenomas causing mass effect or visual loss, or when medical therapy becomes ineffective or intolerable. Modern microsurgical transsphenoidal approaches are potential avenues for resection in pediatric patients. We evaluated the outcomes and safety of this approach.

　　Methods:A retrospective cohort analysis was performed from February 2002 through May 2017 for patients younger than 19 years of age that underwent a transsphenoidal approach for pituitary adenoma resection.

　　Results:Among a total of 634 patients who underwent transsphenoidal approach for pituitary adenoma resection, 24 pediatric cases were identified. Prolactinomas (29.2%) and adrenocorticotropic hormone-secreting (20.8%) pituitary adenomas were the most commonly encountered histologies. Gross total resection was achieved in 75.0% of patients, and complete hormone function normalization was seen in 91.7% of patients. Eight patients (33.3%) required postoperative hormone replacement therapy. Twelve patients (50.0%) underwent fat/fascia use and 1 patient (4.2%) underwent lumbar puncture perioperatively for management of cerebrospinal fluid leak. There were no tumor recurrences during a follow-up period of 24.7 ± 32.1 months.

　　Conclusions:A modern transsphenoidal microsurgical approach proved to be a safe, well-tolerated, and effective modality in the setting of pediatric pituitary adenomas.

　　目的：垂体瘤在儿童中并不常见。虽然药物治疗可以合适治疗催乳素瘤和一些生长激素分泌性肿瘤，但在垂体卒中、大的或较大的垂体瘤引起肿块效应或视力丧失时，或当药物治疗无效或无法忍受时，可采用切除术。现代显微外科经蝶入路是小儿手术切除的潜在途径。我们评估了这种方法的结果和顺利性。

　　简介：垂体瘤占全部儿童颅内肿瘤的3%-6%。1-6例患者的激素水平通常发生变化，这可能对其生长发育、性成熟和生理功能有重要影响。大多数儿童垂体瘤是催乳素瘤，促肾上腺皮质激素（ACTH）分泌型腺瘤也很常见。尽管文献中对成人垂体瘤的外科治疗有很好的描述，但在儿童垂体瘤的外科治疗方面，还缺乏相关的报道。正因为如此，儿童垂体瘤的外科治疗具有挑战性，并且在过去的几十年中经历了的范式转变。虽然经颅入路曾是治疗儿童垂体腺瘤的标准方法，但微创外科技术的进步已经完全改变了这些病变的治疗方法。总的来说，研究表明经蝶入路治疗鞍区病变的并发症发生率和成本效益较低。经扁桃体下入路和经鼻蝶窦入路已成为儿童垂体瘤治疗的标准。自从先前的报道以来，儿童经蝶入路的手术和医疗管理已经取得了的进展，例如立体定向导航的使用，内窥镜技术的应用增加，以及脑脊液（CSF）渗漏修复策略的改进。

　　方法：对接受经蝶窦入路切除垂体瘤的19岁以下患者进行回顾性队列分析。

　　结果：634例经蝶入路垂体腺瘤切除术患者中，24例为儿童。泌乳素瘤（29.2%）和促肾上腺皮质激素分泌腺瘤（20.8%）是常见的组织学表现。总切除率为75.0%，激素功能完全正常者占91.7%。术后激素替代治疗8例（33.3%）。12例（50.0%）患者围手术期使用脂肪/筋膜，1例（4.2%）行腰椎穿刺治疗脑脊液漏。随访24.7±32.1个月，无肿瘤复发。

　　结论：现代经蝶入路显微手术治疗儿童垂体腺瘤是一种顺利、耐受性好、合适的方法。

　　关于美国William T. Couldwell教授

　　美国William T. Couldwell教授目前是国际神经外科学院主席，国际神经外科杂志《Neurosurgical Focus》现任主编，曾任国际脑膜瘤协会主席，美国神经外科医师协会主席等。作为INC国际神经外科医生集团旗下国际神经外科顾问团成员，Couldwell教授擅长脑膜瘤等脑部、颅底、神经肿瘤、垂体肿瘤、颅咽管瘤、癫痫和脑血管神经外科等的外科治疗。拥有海量的脑膜瘤成功手术切除及良好预后病例，对于岩斜区、后颅窝等复杂高难度位置脑膜瘤较为擅长。

　　参考文献：doi:10.1016/j.wneu.2018.11.117