Clinical study of endoscopic treatment of a sellar pituitary adenomas with sellar diaphragm defect

Abstract

Background: Invasive growth of pituitary macroadenomas to the suprasellar region occurs commonly. Pituitary adenomas show varying growth patterns when the sellar diaphragm is absent, and they are often confused with other common tumors in the sellar region. This article explores the clinical features of suprasellar pituitary adenomas with defects of the sellar diaphragm (SPADSD) and evaluates the efficacy of the endoscopic endonasal approach (EEA) for treatment of such tumors. Methods: We performed a detailed examination of records from 19 patients collected prior to surgery. After relevant diseases were excluded, the tumor properties were evaluated according to imaging characteristics. Diagnoses were verified using EEA surgery. The concept of SPADSD was put forward. Postoperative recovery was followed to determine whether EEA is suitable for the treatment of such tumors. Results: In the 19 patients with SPADSD, we found that the tumors were less stressed on the pituitary, and tumors in the suprasellar region often had irregular shapes. During surgery, we took extended supra-saddle approaches and confirmed that unrestricted growth of the tumor was caused by defects in the diaphragm of the sella turcica to the suprasellar region. Recovery was good after surgery, confirming the efficacy of EEA for treatment of these tumors. Conclusion: SPADSD has different clinical features from those of other pituitary tumors and requires careful screening prior to surgery. Endoscopic surgery is the preferred procedure for this type of tumor.

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“…Pituitary adenoma (PA), a common tumor in neurosurgery, originates from the parenchymal cells of adenohypophysis and accounts for about 10–15% of intracranial tumors [ 1 ]. Approximately 1/3 of PA patients show malignant biological behavior including aggressive growth, wrapping, and invasion of the surrounding tissue structure, which can cause neurological and endocrine symptoms; this kind of PA is clinically called invasive PA (IPA) [ 1 – 3 ].…”

“…Pituitary adenoma (PA), a common tumor in neurosurgery, originates from the parenchymal cells of adenohypophysis and accounts for about 10–15% of intracranial tumors [ 1 ]. Approximately 1/3 of PA patients show malignant biological behavior including aggressive growth, wrapping, and invasion of the surrounding tissue structure, which can cause neurological and endocrine symptoms; this kind of PA is clinically called invasive PA (IPA) [ 1 – 3 ]. The pituitary gland is located in the sellar region that is surrounded by important nerves and blood vessels, which explains the high incidence of skull base bone erosion, tumor necrosis, and cystic stroke in IPA patients who are seriously affected by the disease in terms of quality of life [ 4 , 5 ].…”

“…The pituitary gland is located in the sellar region that is surrounded by important nerves and blood vessels, which explains the high incidence of skull base bone erosion, tumor necrosis, and cystic stroke in IPA patients who are seriously affected by the disease in terms of quality of life [ 4 , 5 ]. At present, surgical resection is still the main clinical treatment of PA, but due to the incomplete removal of tumor cells, numerous patients are faced with the risk of neoplasm recurrence and distant metastasis; what is worse, a large proportion of patients with PA were in an advanced stage at diagnosis [ 1 , 3 , 6 ]. Therefore, finding a novel approach for the early prevention and treatment of PA is necessary.…”

Application of MRI images based on Spatial Fuzzy Clustering Algorithm guided by Neuroendoscopy in the treatment of Tumors in the Saddle Region

“…In terms of the typical imaging features of tumors in the sellar region, tumors in the sellar region are mainly located in or above the sellar, and multiaxial scanning is easy to locate and characterize. [7][8][9] For example, the presence and absence of an intrasellar pituitary gland can help distinguish suprasellar and intrasellar tumors, i. e. pituitary tumors. 10,11 However, suprasellar tumors often invade into the sellar and compress the pituitary to move backward, and the imaging appearance is crescent.…”

Three-Dimensional Semantic Segmentation of Pituitary Adenomas Based on the Deep Learning Framework-nnU-Net: A Clinical Perspective

“…Pituitary adenomas (PAs) arise from the pituitary gland; they comprise 10-15% of primary brain tumors and are the third most common type of intracranial tumor [1]. Most of these tumors remain small and do not cause substantial harm or symptoms.…”