neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2018-20-1-21-32neurosurgery-511Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTЭНДОСКОПИЧЕСКОЕ ЭНДОНАЗАЛЬНОЕ УДАЛЕНИЕ ПИТУИЦИТОМ И ОНКОЦИТОМENDOSCOPIC ENDONASAL REMOVAL OF PITUICYTOMAS AND SPINDLE CELL ONCOCYTOMAShttps://orcid.org/0000-0001-9333-9473КалининП. Л.KalininP. L.

125047 Москва, ул. 4-я Тверская-Ямская, 16

16 4th Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0002-5323-1000ФомичевД. В.FomichevD. V.

125047 Москва, ул. 4-я Тверская-Ямская, 16

16 4th Tverskaya-Yamskaya St., Moscow 125047

dfomichev@list.ruhttps://orcid.org/0000-0002-9789-3452ЧерновИ. В.ChernovI. V.

125047 Москва, ул. 4-я Тверская-Ямская, 16

16 4th Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0002-6520-4296КутинМ. А.KutinM. A.

125047 Москва, ул. 4-я Тверская-Ямская, 16

16 4th Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0003-3445-3115ШкарубоА. Н.ShkaruboA. N.

125047 Москва, ул. 4-я Тверская-Ямская, 16

16 4th Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0003-0108-5344ИсмаиловД. Б.IsmailovD. B.

125047 Москва, ул. 4-я Тверская-Ямская, 16

16 4th Tverskaya-Yamskaya St., Moscow 125047

РыжоваМ. В.RyzhovaM. V.

125047 Москва, ул. 4-я Тверская-Ямская, 16

16 4th Tverskaya-Yamskaya St., Moscow 125047

ФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. акад. Н.Н. Бурденко» Минздрава РоссииРоссияN.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of RussiaRussian Federation2018220420182012132Copyright © Калинин П.Л., Фомичев Д.В., Чернов И.В., Кутин М.А., Шкарубо А.Н., Исмаилов Д.Б., Рыжова М.В., 20182018Калинин П.Л., Фомичев Д.В., Чернов И.В., Кутин М.А., Шкарубо А.Н., Исмаилов Д.Б., Рыжова М.В.Kalinin P.L., Fomichev D.V., Chernov I.V., Kutin M.A., Shkarubo A.N., Ismailov D.B., Ryzhova M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/511Введение

Введение. Питуицитомы и веретеноклеточные онкоцитомы (ВКО) относятся к крайне редким доброкачественным (grade I) опухолям хиазмальной области. Клиническая симптоматика и данные нейровизуализации при этих опухолях неспецифичны, в связи с чем в предоперационном периоде диагноз питуицитомы или ВКО установить практически невозможно. Данные опухоли характеризуются обильным кровоснабжением, что зачастую приводит к интенсивному интраоперационному кровотечению, которое, наряду с их высокой плотностью и инфильтративным характером роста, затрудняет радикальное удаление.

Цель исследования – представить собственный опыт хирургического лечения и периоперационного ведения 8 пациентов с ВКО и 5 пациентов с питуицитомами и сопоставить его с данными научной литературы.

Материалы и методы

Материалы и методы. В ретроспективное исследование включены 8 пациентов с ВКО и 5 больных с питуицитомами хиазмальной области, которые были прооперированы с использованием эндоскопического эндоназального транссфеноидального доступа в 2012–2017 гг. в отделении хирургии основания черепа ФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. акад. Н.Н. Бурденко» Минздрава России. Обобщены данные научных источников, посвященных лечению ВКО и питуицитом.

Результаты

Результаты. Тотальное удаление ВКО осуществлено в 4 случаях, субтотальное – в 2, частичное – в 2. Все питуицитомы удалены радикально. Продолженный рост или рецидив ВКО выявлен у 4 пациентов. Послеоперационные осложнения (геморрагические нарушения и нарастание зрительных нарушений) развились у 2 пациентов с ВКО и у 1 пациента с питуицитомой. Положительная динамика зрительных функций после операции наблюдалась у 3 пациентов.

Заключение

Заключение. Оптимальным методом лечения питуицитом и ВКО хиазмальной области является их тотальное удаление с использованием эндоскопического эндоназального доступа. В случае тотальной резекции прогноз благоприятный, однако при нерадикальном удалении опухоль может рецидивировать, вследствие чего потребуется проведение повторной операции и/или лучевой терапии. В случаях медленной бессимптомной прогрессии опухоли может быть предложено наблюдение.

Introduction

Introduction. Pituicytomas and spindle cell oncocytomas (SCO) are very rare benign tumors of sellar and suprasellar region (grade I). In case of these tumors, the clinical symptoms and the results of neuroimaging are not specific, so it is almost impossible to diagnose the pituicytoma or SCO preoperatively. The feature of these tumors is ample blood supply which results in intense intraoperative bleeding. Such events on background of high density and infiltrative growth of the tumors make a radical resection difficult.

Objective is to present our own experience in surgical treatment and perioperative management of 8 SCO and 5 pituicytomas and compare it with the data of the scientific literature.

Materials and methods

Materials and methods. The retrospective study included 8 patients with SCO and 5 patients with pituicytomas that underwent endoscopic endonasal transsphenoidal removal in 2012–2017. Also, the literature data on pituicytoma and SCO were analyzed.

Results

Results. Total resection of SCO was successful in 4 cases, subtotal resection was done in 2 cases, and partial resection was done in 2 cases. All pituicytomas were resected extensively. Relapse of SCO was found in 4 patients. Postoperative complications (visual disorders and hemorrhagic complications) occurred in 2 SCO patients and in 1 pituicytoma patient. Postoperative improvement was seen in 3 patients.

Conclusion

Conclusion. Optimal treatment method for pituicytoma and SCO of sellar and suprasellar region is a total resection using endoscopic endonasal access. The prognosis is favorable if the resection was total, however, if the resection was not extensive a relapse of the tumor can occur, and repeated operation or radiation therapy can be required. In case of slow asymptomatic progression of the tumor, an observation can be continued.

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The authors declare that there are no conflicts of interest present.