侵袭性催乳素腺瘤治疗后海绵窦残留或伴空蝶鞍综合征

目的 探讨侵袭性催乳素(PRL)腺瘤经治疗后海绵窦残留伴空蝶鞍综合征的临床特征和治疗策略.方法 18例侵袭性PRL腺瘤(Knosp分级Ⅲ或Ⅳ级)经治疗后出现海绵窦肿瘤持续残留,首选药物治疗者9例,首选手术治疗结合药物和(或)放疗9例.结果 平均随访55个月,8例PRL水平正常,7例视力改善.14例因鞍内肿瘤吸收遗留空蝶鞍,7例PRL仍升高,其中5例有不同程度的视交叉下疝(P<0.05).PRL水平正常、无临床症状的7例患者采用低剂量溴隐亭治疗达到PRL水平和肿瘤体积的长期控制.结论 PRL腺瘤治疗后海绵窦肿瘤残留伴发空蝶鞍,这一现象应该引起高度重视,尤其对伴有视交叉下疝的病例,长期的密切随访是必需的.无内分泌和压迫症状的海绵窦残留病例可以采用低剂量的药物治疗达到长期的肿瘤控制和内分泌控制.

Cavernous sinus residual tumor accompanying the empty sella syndrome after treatment of invasive prolactinomas

Objective To discuss the clinical characteristics, treatment strategy of the cavernous sinus residual tumor (CSRT) accompanying the empty sella syndrome after treatment of invasive prolactinomas. Method Data from 18 patients with CSRT were retrospectively reviewed. Nine patients initially received bromocriptine as primary treatment; nine patients had initially undergone transcranial or transsphenoidal microsurgery and then received bromocriptine or adjuvant radiotherapy. Results During an average follow-up period of 55 months, serum PRL levels of 8 patients were in normal range and those of 10 patients were above the normal level. Visual symptoms improved in 7 patients while deteriorated in 2 patients. Fourteen patients had a secondary empty sella due to tumor shrinkage. Of those 14 patients, seven still had elevated PRL levels; five had optic ehiasmal herniation by different degrees (P<0.05). Seven of these 18 patients maintain their PRL levels normal with low-dose bromocriptine treatment without significant clinical symptoms. Conclusions After treatment of invasive prolactinomas, great attention should be focused on CSRT accompanying the empty sella, especially in cases with optic chiasmal herniation. CSRT with PRL normalization and no pressure symptoms can be treated with low-dose of bromocriptine so as to achieve long-term tumor volume control and endocrine control.