Background/Objectives: Giant pituitary adenomas (GPAs) pose significant surgical challenges due to their large size, parasellar/suprasellar extensions, and proximity to critical neurovascular structures. Although the endoscopic endonasal approach (EEA) is preferred for pituitary tumors, achieving gross total resection (GTR) in GPAs remains difficult. Additional transcranial approaches may improve resection rates while minimizing morbidity. This study evaluates the impact of endoscopic and combined surgical approaches on resection outcomes using a classification system previously defined in GPA patients treated over the past year.Methods: Among 517 pituitary adenomas treated in our clinic between September 2023 and September 2024, 49 GPA patients underwent endoscopic endonasal, transcranial, or combined surgery. Their medical records and surgical videos were retrospectively reviewed. Data included demographics, symptoms, imaging, surgical details, and follow-up outcomes. Tumor resection rates were analyzed based on the “landmark-based classification”, considering radiological and pathological features and surgical approach.Results: The mean age was 45.5 years (female/male: 14/35). Zone distribution was 8 (Zone 1), 21 (Zone 2), and 20 (Zone 3). GTR was achieved in 34.6%, near-total resection in 36.7%, and subtotal resection in 28.5%. Endoscopic surgery was performed in 41 patients, combined surgery in 7, and a transcranial approach in 1. Complications included diabetes insipidus (9/49), cerebrospinal fluid leakage (2/49), apoplexy (2/49), hypocortisolism (3/49), epidural hematoma (1/49), and epistaxis (1/49).Conclusions: While EEA is effective for Zone 1 and 2 GPAs, Zone 3 tumors often require combined or transcranial approaches for better resection. A multimodal strategy optimizes tumor removal while minimizing morbidity. Individualized surgical planning based on tumor classification is crucial for improving outcomes.
背景/目的：巨大垂体腺瘤（GPAs）因其体积巨大、向鞍旁/鞍上扩展以及邻近重要神经血管结构而带来显著的手术挑战。尽管内镜经鼻入路（EEA）是垂体肿瘤的首选方法，但在GPAs中实现大体全切（GTR）仍然困难。额外的经颅入路可能提高切除率，同时降低并发症发生率。本研究利用过去一年治疗的GPA患者中先前定义的分类系统，评估内镜手术和联合手术入路对切除结果的影响。 方法：在2023年9月至2024年9月期间我院治疗的517例垂体腺瘤患者中，49例GPA患者接受了内镜经鼻、经颅或联合手术。对其病历和手术录像进行了回顾性分析。数据包括人口统计学特征、症状、影像学表现、手术细节和随访结果。基于“基于解剖标志的分类法”，结合影像学、病理学特征及手术入路，分析了肿瘤切除率。 结果：患者平均年龄为45.5岁（女/男：14/35）。分区分布为：8例（1区）、21例（2区）和20例（3区）。大体全切率为34.6%，近全切除率为36.7%，次全切除率为28.5%。41例患者接受了内镜手术，7例接受了联合手术，1例接受了经颅入路。并发症包括尿崩症（9/49）、脑脊液漏（2/49）、卒中（2/49）、皮质醇功能减退（3/49）、硬膜外血肿（1/49）和鼻出血（1/49）。 结论：虽然EEA对1区和2区GPAs有效，但3区肿瘤通常需要联合或经颅入路以实现更好的切除。多模式策略可优化肿瘤切除，同时降低并发症发生率。基于肿瘤分类的个体化手术规划对于改善预后至关重要。
肿瘤(癌症)患者之家