鞍区肿瘤合并鞍区动脉瘤临床分析
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摘要
目的探讨鞍区肿瘤合并鞍区动脉瘤的治疗策略及预后。方法回顾分析2014年3月至2017年10月重庆医科大学附属第一医院神经外科所收治的鞍区肿瘤患者833例病例资料,分为单纯鞍区肿瘤(sellar region tumor,SRT)组(757例)和合并鞍区动脉瘤(sellar region tumor associated with sellar aneurysm,SRTAA)组(76例)。结果鞍区肿瘤类型、大小以及侵袭性对鞍区动脉瘤形成,临床表现差异均无统计学意义(P>0.05)。SRTAA组中7例予以治疗动脉瘤,包括2例(鞍旁脑膜瘤1例,垂体瘤1例)开颅同时行鞍区肿瘤切除及动脉瘤夹闭,2例垂体瘤合并鞍区动脉瘤先介入栓塞动脉瘤后经蝶肿瘤切除(transsphenoidal surgery,TSS),3例为垂体瘤卒中(2例先行TSS、1例开颅)术后再介入栓塞动脉瘤;术后随访6例,肿瘤及动脉瘤均治愈。结论鞍区肿瘤合并鞍区动脉瘤为一偶然现象,临床表现常为鞍区肿瘤所致;根据动脉瘤是否有手术指征(瘤体直径>5 mm或破裂)、与肿瘤毗邻情况以及是否有肿瘤卒中等紧急情况行优先、同期或二期手术治疗动脉瘤,可获得最佳预后。
Objective To explore the treatment strategies and prognosis of sellar region tumor associated with sellar aneurysm. Methods A retrospective analysis was conducted on the data from 833 patients with sellar region tumors diagnosed in our hospital between March 2014 and October 2017. All cases were divided into sellar region tumor group(SRT; n=757) and sellar region tumor groupassociated with sellar aneurysm(SRTAA; n=76). Results There were no significant differences in types, sizes, and invasiveness of tumors between sellar region tumor group and sellar region tumor group associated with sellar aneurysm(P>0.05). Seven cases underwent surgery in SRTAA group including 2 cases(1 case with meningiomas and 1 case with pituitary tumors) who had tumor resection and aneurysm clipping simultaneously,2 cases who had pituitary adenomas associated with sellar aneurysms underwent endovascular treatment of aneurysms followed by transsphenoidal surgery(TSS) for pituitary adenomas and 3 cases underwent embolization of the aneurysm after tumor resection(2 cases for TSS and 1 case for craniotomy) due to pituitary apoplexy. Six patients were followed up and their prognosis was good. Conclusion Sellar region tumor associated with sellar aneurysm is an accidental phenomenon, of which clinical features are often caused by tumors; Preferential, synchronous or second stage of suegery of aneurysm should be performed according to surgery indications(diameter >5 mm or ruptured) of aneurysm, adjacent relationships or emergency situations such as tumor stroke to achieve the good prognosis.
Objective To explore the treatment strategies and prognosis of sellar region tumor associated with sellar aneurysm. Methods A retrospective analysis was conducted on the data from 833 patients with sellar region tumors diagnosed in our hospital between March 2014 and October 2017. All cases were divided into sellar region tumor group(SRT; n=757) and sellar region tumor groupassociated with sellar aneurysm(SRTAA; n=76). Results There were no significant differences in types, sizes, and invasiveness of tumors between sellar region tumor group and sellar region tumor group associated with sellar aneurysm(P>0.05). Seven cases underwent surgery in SRTAA group including 2 cases(1 case with meningiomas and 1 case with pituitary tumors) who had tumor resection and aneurysm clipping simultaneously,2 cases who had pituitary adenomas associated with sellar aneurysms underwent endovascular treatment of aneurysms followed by transsphenoidal surgery(TSS) for pituitary adenomas and 3 cases underwent embolization of the aneurysm after tumor resection(2 cases for TSS and 1 case for craniotomy) due to pituitary apoplexy. Six patients were followed up and their prognosis was good. Conclusion Sellar region tumor associated with sellar aneurysm is an accidental phenomenon, of which clinical features are often caused by tumors; Preferential, synchronous or second stage of suegery of aneurysm should be performed according to surgery indications(diameter >5 mm or ruptured) of aneurysm, adjacent relationships or emergency situations such as tumor stroke to achieve the good prognosis.
引文
[1]李瑗,陈铭,田为中,等.MRI及三维增强MR血管成像对鞍区动脉瘤的诊断价值[J].医学影像学杂志,2012,22(12):1982-1984.
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[5]GUNGOR A,GOKKAVA N,BILEN A,et al.Pituitary Insufficiency and Hyperprolactinemia Associated with Giant Intra-and Suprasellar Carotid Artery Aneurysm[J].Case Rep Med,2015,2015:536.
[6]XU K,YUAN Y,ZHOU J,et al.Pituitary adenoma apoplexy caused by rupture of an anterior communi-cating artery aneurysm:case report and literature review[J].World J Surg Oncol,2015,13:228.
[7]SONG RX,WANG DK,WANG Z,et al.Coexistence of aneurysmal subarachnoid hemorrhage and surgi-cally identified pituitary apoplexy:a case report and review of the literature[J].J Med Case Rep,2014,8:166.
[8]孟国路,赵继宗,隋大立.垂体瘤伴发颅内动脉瘤4例报告[J].中国神经精神疾病杂志,2001,27(6):462-463.
[9]ALMEIDA SILVAA JM,CAMPOS RR,SOUZA RR,et al.Spontaneous subarachnoid haemorrhage from rupture of an anterior communicating artery aneurysm in a patient with pituitary macroadenoma[J].Neu-rocirugia(Astur),2014,25(2):81-85.
[10]OH MC,KIM EH,KIM SH.Coexistence of intracranial aneurysm in 800 patients with surgically confirmed pituitary adenoma[J].J Neurosurg,2012,116(5):942-947.
[11]PARK KY,KIM BM,KIM DJ.Preoperative Coiling of Coexisting Intracranial Aneurysm and Subsequent Brain Tumor Surgery[J].Korean J Radiol,2016,17(6):931-939.
[12]KIM YH,LEE YJ,HAN JH,et al.Association of intracranial aneurysms and meningiomas:a case-control study[J].J Neurosurg,2015,123(2):357-361.
[13]SUSLU HT,BOZBUGA M.Primary brain tumors associated with cerebral aneurysm:report of three cas-es[J].Turk Neurosurg,2011,21(2):216-221.
[14]SHAHLAIE K,OLAVA JE,HARTMAN J,et al.Pituitary apoplexy associated with anterior communicating artery aneurysm and aberrant blood supply[J].J Clin Neurosci,2006,13(10):1057-1062.
[2]程得钧,裘明德,丁永忠,等.酷似垂体瘤的鞍区巨大动脉瘤2例[J].中国神经精神疾病杂志,1996,22(2):85.
[3]CHOI HS,KIM MS,JUNG YJ,et al.Incidental Superior Hypophygeal Artery Aneurysm Embedded within Pituitary Adenoma[J].J Korean Neurosurg Soc,2013,54(3):250-252.
[4]TIAN X,SHU H,ZHANG H,et al.Intracranial hemorrhage due to rupture of an anterior communicating artery aneurysm in a patient with pituitary adenoma[J].J Craniofac Surg,2015,26(2):e154-155.
[5]GUNGOR A,GOKKAVA N,BILEN A,et al.Pituitary Insufficiency and Hyperprolactinemia Associated with Giant Intra-and Suprasellar Carotid Artery Aneurysm[J].Case Rep Med,2015,2015:536.
[6]XU K,YUAN Y,ZHOU J,et al.Pituitary adenoma apoplexy caused by rupture of an anterior communi-cating artery aneurysm:case report and literature review[J].World J Surg Oncol,2015,13:228.
[7]SONG RX,WANG DK,WANG Z,et al.Coexistence of aneurysmal subarachnoid hemorrhage and surgi-cally identified pituitary apoplexy:a case report and review of the literature[J].J Med Case Rep,2014,8:166.
[8]孟国路,赵继宗,隋大立.垂体瘤伴发颅内动脉瘤4例报告[J].中国神经精神疾病杂志,2001,27(6):462-463.
[9]ALMEIDA SILVAA JM,CAMPOS RR,SOUZA RR,et al.Spontaneous subarachnoid haemorrhage from rupture of an anterior communicating artery aneurysm in a patient with pituitary macroadenoma[J].Neu-rocirugia(Astur),2014,25(2):81-85.
[10]OH MC,KIM EH,KIM SH.Coexistence of intracranial aneurysm in 800 patients with surgically confirmed pituitary adenoma[J].J Neurosurg,2012,116(5):942-947.
[11]PARK KY,KIM BM,KIM DJ.Preoperative Coiling of Coexisting Intracranial Aneurysm and Subsequent Brain Tumor Surgery[J].Korean J Radiol,2016,17(6):931-939.
[12]KIM YH,LEE YJ,HAN JH,et al.Association of intracranial aneurysms and meningiomas:a case-control study[J].J Neurosurg,2015,123(2):357-361.
[13]SUSLU HT,BOZBUGA M.Primary brain tumors associated with cerebral aneurysm:report of three cas-es[J].Turk Neurosurg,2011,21(2):216-221.
[14]SHAHLAIE K,OLAVA JE,HARTMAN J,et al.Pituitary apoplexy associated with anterior communicating artery aneurysm and aberrant blood supply[J].J Clin Neurosci,2006,13(10):1057-1062.