扩大额下硬膜内入路显微切除大型垂体腺瘤

目的 探讨扩大额下硬膜内入路显微手术切除大型和巨大型垂体腺瘤的手术方式和临床疗效。方法 采用扩大额下硬膜内入路切除体腺瘤,对生长入蝶窦内的肿瘤则磨除蝶骨平板切除窦内肿瘤,显微切除鞍上肿瘤时应解剖出垂体柄和受挤压的垂体组织并加以保护,以免术中损伤。结果 16例大型和巨大型垂体瘤全切除13例（81.25％）,次全切除3例,无重残及死亡病例。结论 该手术入路的显微手术能有效地提高大型和巨大型垂体腺瘤的全切除率,亦适用于鞍区的肿瘤的显微手术。     

巨大型垂体腺瘤的显微外科手术治疗

目的 探讨扩大前颅底经纵裂经平台蝶窦入路手术治疗巨大垂体腺瘤的疗效。方法 1999年12月～2004年12月，对21例巨大型垂体腺瘤采用扩大前颅底经纵裂经平台蝶窦入路进行显微外科手术治疗，术前均经MRI检查，肿瘤最长径平均4、8（4．0～7．5）cm。结果 肿瘤全切除18例（85．7％），次全切除3例（14．3％），无手术死亡病例。术后患者症状均有所改善，但发生脑脊液漏1例，短时尿崩4例，2例未能保留嗅神经，1例仅保留1侧。术后平均随访2．5（0．5～5．5）年，复查内分泌检查、MRI未见复发。结论 此入路视野广阔、暴露良好、无严重并发症，可提高巨大垂体腺瘤的手术效果。     

经颅显微手术切除垂体腺瘤

目的 探讨提高垂体腺瘤手术疗效的技术与方法。方法 回顾性分析246例患者临床资料，其中经翼点或扩大翼点人路187例，经眶上锁孔入路39例，经额下入路20例。结果 肿瘤全切151例（61．4％），次全切79例（32．1％），大部分切除16例（6．5％），死亡3例，随访3个月～1年，16例复发行放射治疗或再次手术治疗。结论 基于肿瘤的大小、质地、肿瘤侵犯的范围及术者对手术方式的认识和掌握熟练程度选择合适的手术入路；术中注意对视神经及视交叉、垂体柄、下丘脑和穿支动脉的保护，肿瘤残余或呈侵袭者术后辅以放疗，可显著提高垂体腺瘤的手术疗效。     

经口鼻蝶窦显微外科治疗垂体腺瘤

目的：探讨垂体腺瘤的诊断和经口鼻蝶窦显微手术的方法及经验。方法：经口鼻蝶窦显微外科切除垂体腺瘤30例，（微腺瘤8例，大腺瘤18例，巨大腺瘤4例，侵袭性腺瘤16例），观察其治疗效果。结果：肿瘤全切除26例（86.7%），次全切除4例，无死亡病例，术后并发症少。25例（83.3%）随访6个月-5年，痊愈22例（88%），好转3例，复发1例。结论：MR对选择手术入路有重要作用。经口鼻蝶窦显微手术是治疗垂体腺瘤的有效、安全的一种方法。     

垂体腺瘤显微手术治疗探讨

目的 探讨垂体腺瘤的显微手术治疗方法。方法 PRL瘤14例，GH瘤8例，ACTH瘤5例，多分泌腺瘤10例，无功能瘤13例；经翼点入路48例，2例经右眉上锁孔入路。结果 全切除肿瘤35例，大部分切除9例，部分切除6例。MRI随诊3个月～2年，4例有复发。结论 翼点入路垂体腺瘤切除是治疗垂体腺瘤及复发垂体腺瘤的有效方法。     

直接经鼻腔蝶窦入路显微切除垂体腺瘤疗效观察

目的观察应用直接经鼻腔蝶窦入路显微手术治疗垂体腺瘤的效果。方法对18例垂体腺瘤患者实施直接经鼻腔-蝶窦入路显微手术切除,回顾性分析患者的临床资料。结果垂体腺瘤全切除12例,大部分切除5例,部分切除1例,无死亡病例。术后出现脑脊液漏2例,尿崩症4例,均经对症处理后痊愈,未出现其他严重并发症,术后随访3~6个月,复查内分泌指标均明显好转,视野缺损和视力减退者均有明显改善。结论直接经鼻腔蝶窦入路显微切除垂体腺瘤,手术时间短,出血量少。恢复快,并发症少,值得临床推广。     

经口鼻蝶窦显微切除大型垂体腺瘤

目的 探讨经口鼻蝶窦显微切除大型垂体腺瘤的手术指征、显微外科操作要点及临床疗效。方法 自1998年5月～2003年5月，采用经口鼻蝶窦入路切除大型垂体腺瘤87例，对其临床资料进行回顾性总结。结果 其中81例肿瘤在手术显微镜下全切除，全切除率为93％，次全切除6例。术后脑脊液鼻漏7例，其中1例继发颅内感染死亡，其余经治疗后痊愈。全部病例随访2～60个月(平均38．6个月)，手术全切除的病例目前均无复发，次全切除的2例分别于术后40个月和56个月复发。结论 垂体腺瘤手术疗效取决于肿瘤的切除程度；经口鼻蝶窦入路显微切除大型垂体腺瘤是一种安全有效的方法，手术病例的选择和显微手术技巧是肿瘤能否全切除的关键因素。     

大型垂体腺瘤的显微手术治疗

目的 探讨大型垂体腺瘤的显微手术治疗方法。方法 根据肿瘤的部位、质地、内分泌测定和MRI检查T2信号特点选择手术入路切除肿瘤，其中82例经翼点入路，22例经额下入路，6例经蝶窦入路，3例行额下经蝶窦入路。术后全部进行放疗。结果 102例(90．3％)显微镜下全切，11例(9．7％)次全切除。术后死亡2例(1．8％)。术后视力视野改善98例(86．7％)，无变化15例(13．3％)。术后5年内复发6例(6．3％)。结论 采用显微外科技术，针对肿瘤的特点选择不同的手术入路及综合治疗是提高大型垂体肿瘤全切率、降低死亡率和复发率的关键。     

经颅显微外科手术切除垂体腺瘤

报道经颅显微外科切除垂体腺瘤２８例，选择额下、翼点、额－颞联合三种不同术式入路和显微手术技巧。所有病例术前接受ＣＴ或／和ＭＲＩ扫描检查，经颅内路应用显微外科技术对肿瘤施行全切除。肿瘤全切除２０例，次全切除８例，无手术死亡。术后平均２年以上随访无肿瘤复发。认为肿瘤鞍上部分较大或瘤块向鞍上周围伸展，经颅入路是较理想的途径。     

显微经蝶入路垂体腺瘤切除术垂体功能的保护策略

目的总结垂体腺瘤经蝶窦手术,术中垂体柄和垂体组织的辨认与保护的体会。方法显微镜下经鼻蝶入路切除的垂体腺瘤病人50例,通过影像学资料和术中显微解剖,仔细辨认正常垂体组织、垂体柄与病变组织的关系,尽可能切除垂体腺瘤组织,保护垂体功能,减少术后并发症。结果肿瘤全切除40例(80. 0%,40/50),次全切除8例(16. 0%,8/50),大部分切除2例(4. 0%,2/50)。术中垂体柄及正常垂体组织均保留良好。术后暂时性尿崩者8例(16. 0%,8/50),无永久性尿崩;术后随访3～12个月,所有病人垂体功能均明显改善。结论显微经蝶窦手术中,术者对正常垂体、垂体柄及肿瘤组织的准确辨认,才能达到保留垂体功能的治疗目标。     

Treatment of Pituitary Carcinomas and Atypical Pituitary Adenomas: A Review

Atypical pituitary adenomas (APAs) are aggressive tumors, harboring a Ki-67 (MIB-1) staining index of 3% or more, and positive immunohistochemical staining for p53 protein, according to the World Health Organization (WHO) classification in 2004. Pituitary carcinomas (PC) usually develop from progressive APAs and predominantly consist of hormone-generating tumors, defined by the presence of disseminations in the cerebrospinal system or systemic metastases. Most of the cases with these malignant pituitary adenomas underwent surgeries, irradiations and adjuvant medical treatments, nevertheless, the therapies are mainly palliative. Recently, the efficacy of temozolomide (TMZ), an orally administered alkylating agent, has been reported as an alternative medical treatment. However, some recent studies have demonstrated a significant recurrence rate after effective response to TMZ. Further clinical and pathological researches of malignant pituitary adenomas will be required to improve the outcome of patients with these tumors.     

Pituitary apoplexy. Report of 25 patients

A series of 25 patients with a clinical diagnosis of pituitary apoplexy (PA) is reviewed. It included 14 men and 11 women aged between 20 to 79 years (mean age: 54 years). Twenty-two patients did not know that they had a pituitary tumor when the apoplexy occurred. A precipitating event was found in 3 cases. Symptoms and signs ranged from isolated ocular paresis to a deep coma. Seventeen patients experienced a decrease in their visual acuity. CTscan and MRI showed a pituitary adenoma in all cases, a hemorrhage was also present in 10 out of the 24 CTscans, and in all the 8 MRI performed. Twenty patients underwent surgery; 18 of them by a transsphenoidal approach. A complete recovery of visual acuity was observed in 75% of patients operated within the week following the onset of symptoms, and in 56% of patients operated later on. There was no case of complete visual recovery among the blind patients. Pituitary apoplexy is a clinical concept. It applies only to symptomatic cases. It is generally a complication of a pituitary adenoma which is in most cases unknown. There are different degrees of severity; PA can even be life-threatening. The principal aim of surgery in the acute phase is the improvement of visual prognosis. In our series, blind patients or those with a history of visual loss for more than a week or with a blindness had a poorer prognosis.     

Pituitary Apoplexy Caused by Hemorrhage From Pituitary Metastatic Melanoma: Case Report

Melanoma metastases to the pituitary gland are extremely rare, with only a few reported cases. We report an unusual case of pituitary metastatic melanoma in which the patient presented with pituitary apoplexy. A 68-year-old man presented general fatigue and anorexia following sudden headache. Neurological examination disclosed bitemporalhemianopsia. Computed tomography (CT) scans revealed a suprasellar mass including intratumoral hematoma. Magnetic resonance (MR) images demonstrated a circumscribed mass lesion in the intra- and suprasellar regions, compressing the optic chiasm. Surgical exploration was performed through a transsphenoidal approach, and a mixture of tumor and necrotic tissue with old hematoma was obtained. The histological examination of the specimen revealed a partly necrotic, malignant tumor with focal melanotic pigmentation. Histopathologically, the diagnosis was consistent with pituitary apoplexy caused by hemorrhage from pituitary metastatic melanoma.     

Pituitary abscesses. Report of three cases

Three cases of pituitary abscess are presented. In spite of improvements in radiological evaluation, preoperative diagnosis of pituitary abscess is quite difficult and definite preoperative diagnosis is rare in the literature. In our three cases, diagnosis was made postoperatively. Pituitary abscesses are associated with high mortality and morbidity. When first suspected, prompt antibiotic therapy should be considered. Early operative drainage seems to be an important factor in decreasing this high mottality and morbidity.     

Pituitary alcohol injection for cancer pain

The use of trans-sphenoidal pituitary alcohol injection was assessed in a district general hospital for the treatment of diffuse bilateral cancer pain in 26 patients. Fourteen patients received a total of 43 injections. Hormonal and non-hormonal dependent cancers were treated, with complete pain relief in ten patients and partial relief in a further seven patients. The duration of relief was variable, and usually less than 6 weeks, although two patients had complete pain relief for 5 and 7 months respectively. No cases of meningitis or cerebrospinal fluid rhinorrhoea occurred. Nasal antiseptics and vasoconstrictors were not used. Temporary pupil dilatation occurred in eight patients, of whom one had prolonged blurred vision for small print. Transient diabetes insipidus was common (53%), although only five patients needed permanent treatment. Death from their disease occurred in 65% of patients within 3 months. Survival was shorter than in series from specialist centres, suggesting later referral for pain relief. The technique is an inexpensive and valid form of treatment for cancer pain in a district hospital, but should not be undertaken lightly in view of the possible complications.     

垂体腺瘤性男性不育

垂体腺瘤是男性不育的重要病因。现代内分泌和影像学检查能够早期诊断垂体腺瘤引起的男性不育症。针对垂体腺瘤的病因治疗是治疗此类不育症的最佳选择。     

显微镜下经单鼻孔蝶窦入路切除垂体腺瘤

目的评价显微镜下经单鼻孔蝶窦入路切除垂体腺瘤的疗效. 方法采用经单鼻孔蝶窦入路行垂体腺瘤切除术20例,其中微腺瘤8例(<10 mm),小腺瘤8例(10～20 mm),中腺瘤3例(20～30 mm),大腺瘤1例(>30 mm);PRL腺瘤9例,GH腺瘤6例,ACTH腺瘤5例. 结果本组20例无并发症,平均随访5(2～10)个月,患者临床症状较术前均有不同程度改善,手术效果良好. 结论经单鼻孔蝶窦入路垂体瘤切除术效果好,术中损伤小,患者痛苦少,术后康复快,没有或较少出现并发症.     

Pilot Study on Early Postoperative Discharge in Pituitary Adenoma Patients: Effect of Socioeconomic Factors and Benefit of Specialized Pituitary Centers

Introduction Pituitary neoplasms are benign entities that require distinct diagnostic and treatment considerations. Recent advances in endoscopic transsphenoidal surgery have resulted in shorter lengths of stay (LOS). We implemented a postoperative day (POD) 1 discharge paradigm involving a multidisciplinary approach and detailed preoperative evaluation and review of both medical and socioeconomic factors. Methods The experience of a single neurosurgeon/ears, nose, throat (ENT) team was reviewed, generating a preliminary retrospective database of the first 30 patients who underwent resection of pituitary lesions under the POD 1 discharge paradigm. We assessed multiple axes from their preoperative, in-house, and postoperative care. Results There were 14 men and 16 women with an average age of 53.8 years (range: 27–76 years). There were 22 nonsecretory and 8 secretory tumors with average size of 2.80 cm (range: 1.3–5.0 cm). All 30 patients underwent preoperative ENT evaluation. Average LOS was 1.5 ± 0.7 days. A total of 18 of 30 patients were discharged on POD 1. The insurance status included 15 with public insurance such as emergency Medicaid and 15 with private insurance. Four patients had transient diabetes insipidus (DI); none had permanent DI. Overall, 28 of 30 patients received postoperative steroids. Factors that contributed to LOS > 1 day included public insurance status, two or more medical comorbidities, diabetes mellitus, transient panhypopituitarism, and DI. Conclusion The implementation of a POD 1 discharge plan for pituitary tumors is feasible and safe for elective patients. This implementation requires the establishment of a dedicated Pituitary Center model with experienced team members. The consistent limitation to early discharge was socioeconomic status. Efforts that incorporate the analysis of social disposition parameters with proper management of clinical sequelae are crucial to the maintenance of ideal LOS and optimal patient outcomes.