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文献名称

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Results and risk factors for recurrence following endoscopic endonasal transsphenoidal surgery for pituitary adenoma
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文献简介

出版社:Clinical Neurology and Neurosurgery

作者:Imithri Bodhinayakea,1, Malte Ottenhausena,1, Michael A. Mooneya, Kartik Kesavabhotlaa, Paul Christosb, Justin T. Schwarza, John A. Boockvara,∗

编号:10.1016/j.clineuro.2014.01.020

关键字:Endoscopic Pituitary Recurrence Risk factors Transsphenoidal

年份:2014点击量:571

文献摘要

Background:  

        Endoscopic  endonasal  (EE)  transsphenoidal  surgery  is  an  important  surgical  approach  to the  treatment  of  sellar  pathology,  particularly  for  pituitary  adenomas.  Risk  factors  for  the  radiographic recurrence  of  pituitary  adenomas  resected  using  a  purely  endoscopic  approach  have  not  been  established.This  study  investigates  outcomes  and  identifies  risk  factors  for  recurrence  following  EE  transsphenoidal surgery  for  pituitary  adenoma.


Methods:  

        We  performed  a  retrospective  review  of  64  patients  with  pituitary  adenomas  undergoing  EE surgery  by  a  single,  right-handed  surgeon  preferentially  operating  through  the  right  nares.  Post-operative MRI  studies  were  utilized  to  monitor  for  residual  disease  or  disease  recurrence.


Results:  

        Residual  tumor  was  found  in  31.2%  of  patients.  Over  a  median  follow-up  period  of  23.1  months (range  4–62.5),  4  (20%)  of  these  patients  showed  recurrence.  Two  patients  with  inconclusive  post-operative  imaging  had  subsequent  imaging  consistent  with  recurrence,  making  the  total  recurrence  in our  series  9.4%.  While  no  statistically  significant  effects  of  gender,  age  or  history  of  previous  treatment were  seen,  amenorrhea  on  presentation  and  maximum  tumor  diameter  >10  mm  were  significant  risk factors  for  radiographic  recurrence  (p  =  0.044  and  0.005,  respectively).  No  predominant  side  of  residual tissue  was  identified  in  these  tumors  operated  through  the  right  nares.


Conclusions:  

        Only  20%  of  patients  with  residual  tumor  developed  recurrent  disease  over  a  median  follow up  of  23.1  months.  This  recurrence  rate  may  be  an  important  consideration  in  cases  where  gross  total resection  is  not  feasible.  Preferentially  operating  from  the  right  does  not  seem  to  influence  the  location of residual tumor.

 

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