沉默促肾上腺皮质激素腺瘤 (SCA) 是一种高危垂体神经内分泌肿瘤 (PitNET)，与其他无功能的 PitNET 相比，它表现出更具攻击性的行为。观察到一些 SCA 在全切除 (TR) 后复发。我们的目的是探讨内镜鼻内手术治疗SCAs的远期疗效，并探讨术后最佳治疗方案。回顾性收集367例接受内镜鼻内手术的SCAs的临床资料和术中视频。根据术后3个月的MRI，将患者分为TR组和次全切除（STR）组。根据术中近距离观察肿瘤与垂体、膈肌、内壁海绵窦的关系，TR组患者进一步分为大体全切除（GTR）组和近全切除（NTR）组。 STR 组患者被细分为 STR 后观察（STR ob）和 STR 后辅助立体定向放射外科（SRS）（STR SRS）。 Kaplan-Meier 分析用于比较这些亚组之间的无事件生存率。头痛 (27.5%) 和视力丧失 (55.3%) 是最常见的症状。 167 名 (45.5%) 患者术中证实海绵窦 (CS) 侵犯。术后，175例（47.7%）、83例（22.6%）、32例（8.7%）和77例（21%）患者分别被分为GTR组、NTR组、STR ob组和STR SRS组。平均随访时间为 40.9 ± 25.8 个月。 GTR、NTR、STR ob 和 STR SRS 组中分别有 0、17（20.5%）、9（28.1%）和 4（5.2%）名患者出现 PitNET 复发或进展。 NTR 组的无事件生存分布与 STR ob 组相似 (P = .696)，显着低于 STR SRS 组 (P = .008)。促肾上腺皮质激素（ACTH）阴性 SCA 术前 ACTH 水平较低，并且比 ACTH 阳性 SCA 更容易侵入 CS。CS 侵入常见于 SCA，通常排除 GTR。建议进行根治性手术和密切随访。应考虑对残余肿瘤进行术后早期辅助 SRS。版权所有 © 神经外科医生大会 2024。保留所有权利。

Silent corticotroph adenoma (SCA) is a high-risk pituitary neuroendocrine tumor (PitNET) which exhibits more aggressive behavior than other nonfunctioning PitNETs. Some SCAs are observed to recur after total resection (TR). We aim to discuss the long-term outcomes after endoscopic endonasal surgery for SCAs and explore optimal treatment after operation.Clinical data and intraoperative videos from 367 SCAs who underwent endoscopic endonasal surgery were retrospectively collected. Patients were categorized into TR and subtotal resection (STR) groups according to 3-month postoperative MRIs. Based on close-up intraoperative observation of the relationship between tumor and pituitary gland, diaphragm, and medial wall cavernous sinus, patients in the TR group were further subdivided into gross total resection (GTR) and near total resection (NTR) groups. Patients in the STR group were subdivided as STR followed by observation (STR + ob) and STR followed by adjuvant stereotactic radiosurgery (SRS) (STR + SRS). Kaplan-Meier analysis was used to compare the event-free survival among these subgroups.Headache (27.5%) and vision loss (55.3%) were the most common presenting symptoms. Cavernous sinus (CS) invasion was confirmed intraoperatively in 167 (45.5%) patients. After operation, 175 (47.7%), 83 (22.6%), 32 (8.7%), and 77 (21%) patients were divided into GTR, NTR, STR + ob, and STR + SRS groups, respectively. The mean follow-up time was 40.9 ± 25.8 months. There were 0, 17 (20.5%), 9 (28.1%), and 4 (5.2%) patients noted to have PitNET recurrence or progression in GTR, NTR, STR + ob, and STR + SRS groups, respectively. Event-free survival distribution in the NTR group was similar to that in the STR + ob group (P = .696), which was significantly lower than that in the STR + SRS group (P = .008). Adrenocorticotropic hormone (ACTH)-negative SCAs have lower preoperative ACTH levels and were more likely to invade CS than ACTH-positive SCAs.CS invasion was commonly seen in SCAs, often precluding GTR. Radical surgery and close follow-up were proposed. Early postoperative adjuvant SRS for remnant tumor should be considered.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.