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Yıl:2001; Cilt: 14; Sayı: 4>> Özet
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Düşünen Adam: Psikiyatri ve Nörolojik Bilimler Dergisi; 2001;14(4):246-249
Hormon inaktif hipofiz adenomlarında mikrocerrahi tedavi
M Erşahin, K Kılıç, C Özdoğan, T Kaner, A Bakırcı, M Kara
Hormon sekrete etmeyen tümörler, hipofiz adenomlarnın yaklaşık olarak % 40' nı oluşturmaktadır. Radyolojik olarak görüntüleri diğer adenomlara benzer ve doğru tanı endokrinolojik ve histopatolojik inceleme ile konur. Endokrinolog ve nöroşirürjyenlerin yakın işbirliği gerektiren bu tümölerde takip ve tedavi konusundaki tartışma sürmektedir. Haydarpaşa Numune Eğitim ve Araştırma Hastanesi Beyin Cerrahisi Kliniğinde Ocak 1994 Eylül 1999 tarihleri arasında cerrahi tedavi uygulanan 41 Hipofiz adenom olgusundan inaktif adenom olarak değerlendirildi 16 olgu çalışmanın konusunu oluşturmaktadır. 16 olgudan 14 olgu transnazal-transsfenoidal cerrahi ile 2 olgu ise kombine yaklaşımla önce transkranial yolla daha sonra transnazal- transsfenoidal yolla ameliyat edilmiştir Çalışmammızda transsfenoidal yolla ameliyat edilen olgularda başarı % 85 olarak saptandı, transkranial yolla ameliyat edilen 2 olgunun birinde total birinde ise parsiyel rezeksiyon saptanmıştır. Hormon inaktif adenomların yakın takip edilmeleri, kitle etkisi oluşturan adenomların cerrahi olarak eksize uygun olgularda transnazal-transsfenoidal cerrahinin güvenli etkin bir yöntem olduğu, bu yöntemin uygun olmadığı olguların transkranial yolla ve/veya kombine yaklaşımla ameliyat edilmesi gerektiği çalışmamızda görülmekte ve sonuçlar literatür eşliğinde tartışılmaktadır.
Almost 40 percent of all pituitary adenomas are non-functional. Radiologically they appear like other adenomas and the definitive diagnosis is based on the endocrinologic and the histopathologic findings. In these tumors which necessitates close collaboration of neurosurgeons and endocrinologists, controversies still exist in treatment and follow-up modalities. In the Neurosurgery Department of Haydarpasa Numune Training and Research Hospital, between January 1994 and September 1999, 41 patients were operated on for pituitary adenomas, 16 of those which were non-functional are presented here. 14 out of 16 cases were operated on by transsphenoidal ivme. and 2 cases by transcranial and transsphenoidal combined surgery. In patients operated on by transsphenoidal rolde the sucess rate was 85 %. In one of two patients operated on combined surgery the tumor removal was total, wheras in the second one the adenoma could only be partially removed. Hormonally non-functional adenomas most be followed-up carefidly and operated on when they present with mass effect. Transsphenoidal surgery is an effective and secure way of treatment in selected cases wheras in others, transcranial and combined surgery may be used. The results are discused in the light of the literature.

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