The transphenoidal procedure has become the preferred approach in the surgical management of sellar/parasellar tumors. Nevertheless, specific indications remain for the transcranial approach and the objective of this review is to evaluate the available data on outcomes following transcranial or transphenoidal approaches to sellar/parasellar tumors. We assess the indications used for each approach and parameters that favor one over the other. Factors such as tumor size, consistency and configuration are important variables in choosing the transcranial approach. Other important considerations include persistent visual loss after incomplete decompression via the transphenoidal route, ectatic midline carotid arteries, co-existent intracranial aneurysms and sphenoid sinusitis. We review the data on visual and endocrinological outcomes following the transcranial or transphenoidal approach and provide an argument that, while there appears to be a trend towards greater visual improvement after transcranial surgery for large-to-giant pituitary adenomas, this benefit is offset by a greater risk of postoperative pituitary dysfunction. There is no difference in the rate of recurrence between the two procedures in the published literature. Overall, craniotomies will continue to play a role in the management of patients with sellar/parasellar tumors, although patient selection and careful preoperative evaluation are key elements in choosing the most appropriate approach.

译文

:经蝶突手术已成为蝶鞍/鞍旁肿瘤手术治疗的首选方法。然而,经颅入路的具体指征仍然存在,本综述的目的是评估经颅或经蝶入路治疗鞍/鞍旁肿瘤后可获得的结局数据。我们评估了每种方法所使用的适应症和参数,它们相互之间有利。肿瘤大小,一致性和构型等因素是选择经颅入路的重要变量。其他重要的考虑因素包括经蝶窦途径减压不完全后持续的视力丧失,直肠中线颈动脉,并存的颅内动脉瘤和蝶窦炎。我们回顾了经颅或经蝶入路方法后的视觉和内分泌结果的数据,并提出了一个观点,即对于大到大的垂体腺瘤,经颅手术后似乎有更大的视觉改善趋势,但这种益处被术后垂体功能障碍的风险更大。在已发表的文献中,这两种方法的复发率没有差异。总体而言,开颅手术将继续在蝶鞍/鞍旁肿瘤患者的治疗中发挥作用,尽管患者选择和仔细的术前评估是选择最合适方法的关键因素。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录