Endoscopic Endonasal Surgery in Recurrent and Residual Pituitary Adenomas after Microscopic Resection

Alahmadi, Hussein; Dehdashti, Amir R.; Gentili, Fred

doi:10.1055/s-2011-1274234

Cited by 10 publications

(13 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We have previously reported how these challenging cases represent an important population that contemporary pituitary surgeons face in revising patients with recurrent tumor after debulking by an alternate modality. 1 However, including these patients with previous incompletely debulked tumor may have increased the difficulty of surgery in this study's population, which may account for the differences between this study and reports of greater GTR and extent of resection.…”

Section: Outcomes Of Case Seriescontrasting

confidence: 52%

Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas: institutional experience and predictors of extent of resection

Juraschka

Khan

Godoy

et al. 2014

JNS

Self Cite

179

View full text Add to dashboard Cite

Pituitary adenomas are the third most common intracranial neoplasm, accounting for 10%-25% of intracranial neoplasms with a prevalence of 16.9% in autopsy studies. 6 A subgroup of these lesions that are particularly challenging to manage are those that can be classified as large or giant pituitary adenomas.2,3 Giant pituitary adenomas have classically been described as those ≥ 4 cm in maximum diameter, while large pituitary adenomas currently lack a consistent definition in existing literature. 3,7,8,11,16,17 Object. While the use of endoscopic approaches has become increasingly accepted in the resection of pituitary adenomas, limited evidence exists regarding the success of this technique for patients with large and giant pituitary adenomas. This study reviews the outcomes of a large cohort of patients with large and giant pituitary adenomas who underwent endoscopic endonasal transsphenoidal surgery at the authors' institution and focuses on identifying factors that can predict extent of resection and hence aid in developing guidelines and indications for the use of endoscopic endonasal transsphenoidal surgery versus open craniotomy approaches to large and giant pituitary adenomas.Methods. The authors reviewed 487 patients who underwent endoscopic endonasal transsphenoidal resection of sellar masses. From this group, 73 consecutive patients with large and giant pituitary adenomas (defined as maximum diameter ≥ 3 cm and tumor volume ≥ 10 cm 3 ) who underwent endoscopic endonasal transsphenoidal surgery between January 1, 2006, and June 6, 2012, were included in the study. Clinical presentation, radiological studies, laboratory investigations, tumor pathology data, clinical outcomes, extent of resection measured by volumetric analysis, and complications were analyzed.Results. The mean preoperative tumor diameter in this series was 4.1 cm and the volume was 18 cm 3 . The average resection rate was 82.9%, corresponding with a mean residual volume of 3 cm 3 . Gross-total resection was achieved in 16 patients (24%), near-total in 11 (17%), subtotal in 24 (36%), and partial in 15 (23%). Seventy-three percent of patients experienced improvement in visual acuity, while 24% were unchanged. Visual fields were improved in 61.8% and unchanged in 5.5%. Overall, 27 patients (37%) experienced a total of 32 complications. The most common complications were sinusitis (14%) and CSF leak (10%). Six patients underwent subsequent radiation therapy because of aggressive tumor histopathology. No deaths occurred in this cohort of patients. Statistically significant predictors of extent of resection included highest Knosp grade (p = 0.001), preoperative tumor volume (p = 0.025), preoperative maximum tumor diameter (p = 0.002), hemorrhagic component (p = 0.027), posterior extension (p = 0.001), and sphenoid sinus invasion (p = 0.005).Conclusions. Endoscopic endonasal transsphenoidal surgery is an effective treatment method for patients with large and giant pituitary adenomas, which results in high (> 80%) rates of resection and improvem...

show abstract

Section: Outcomes Of Case Seriescontrasting

confidence: 52%

Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas: institutional experience and predictors of extent of resection

Juraschka

Khan

Godoy

et al. 2014

JNS

Self Cite

179

View full text Add to dashboard Cite

show abstract

“…They determined recurrence in 51% and 27% of those with and without cavernous sinus invasion, respectively (5). A strong correlation has been determined between cavernous sinus invasion and recurrence in nonfunctioning pituitary adenomas in other studies and our study (1,6,(8)(9)(10)(12)(13)(14).…”

Section: Diri H Et Al: Prognostic Factors Of Sellar Region Tumorsmentioning

confidence: 58%

Prognostic factors obtained from long-term follow-up of pituitary adenomas and other sellar tumors

Diri¹,

Özaslan²,

Kurtsoy³

et al. 2014

Turkish Neurosurgery

View full text Add to dashboard Cite

AIm: Pituitary adenomas do not have a single factor of aggressive behavior or recurrence. The objective of this study was to determine factors influencing the prognosis in pituitary adenomas. mATERIAL and mETHods: 243 patients who were operated between January 2000 and June 2012 were included in this retrospective study. Demographic data, age at diagnosis, date of diagnosis, date of operation, type of operation, post-operative medications, pre-and postoperative hormone levels, and MRI findings were evaluated in each patient. REsuLTs:The rate of total resection of sellar tumors was less than 50% in our patient population. The prognosis was better in cases with total resection. Tumor size was a poor prognostic factor in sellar tumors. Female sex was a poor prognostic factor in acromegaly and male sex in prolactinoma. The prognosis was worse in patients with cavernous sinus invasion. In acromegaly, pre-operative level of 850 ng/ml for IGF-1 was noted as a possible prognostic cut-off value.CoNCLusIoN: Long-term follow-up results of our study suggest that factors common to all sellar tumors including tumor type, tumor size, total resection, and cavernous sinus invasion and tumor type-specific factors including sex and hormone levels play important roles in the prognosis. BuLGuLAR: Olgularda sellar bölge tümörlerinin total rezeksiyon oranının % 50'den daha az olduğu görüldü. Total rezeksiyon yapılan olguların prognozunun daha iyi olarak bulundu. Sellar tümörlerde büyüklüğün prognozu olumsuz etkilediği tespit edildi. Akromegalide kadın, prolaktinomada erkek cinsiyetin prognozu kötü idi. Kavernöz sinüs invazyonu olan hipofiz adenomu olgularında prognoz daha kötü olarak saptandı. Akromegalide preoperatif IGF-1 için 850 ng/ml değerinin prognoz açısından bir cut-off değeri olabileceği görüldü. soNuÇ: Çalışmamızdaki uzun süreli takiplerden vardığımız sonuçlara göre tümör çeşidi, tümör büyüklüğü, total rezeksiyon ve kavernöz sinüs invazyonu gibi bütün sellar tümörlerde ortak olan faktörler ile cinsiyet ve hormon düzeyleri özellikleri gibi tümör çeşitlerine spesifik faktörler prognozda önemli rol oynamaktadır. KEywoRdsANAHTAR sÖZCÜKLER: Hipofiz adenomu, Sellar bölge tümörü, Prognoz, Takip

show abstract

“…There are no reports describing sufficiently long-term followup results after salvage surgery performed for recurrent/residual NFPAs. Although Rudnik et al, 30 Cavallo et al, 31 Hwang et al, 32 Tajudeen et al, 33 and Alamadi et al 34 reported salvage surgery on recurrent NFPA, they did not describe long-term follow-up results after reoperation. Benveniste et al 35 and Mattozo et al 36 reported that, although their study subjects included patients with functional and nonfunctional tumors, postreoperative regrowth occurred in 15% and 23% during the median follow-up periods of 32 (range, 1-109) mo and 30 (range, 3-63) mo after the second surgery, respectively.…”

Section: Postsalvage Surgery For Recurrent/residual Tumorsmentioning

confidence: 99%

Postsurgical Salvage Radiosurgery for Nonfunctioning Pituitary Adenomas Touching/Compressing the Optic Chiasm: Median 13-Year Postirradiation Imaging Follow-up Results

et al. 2018

View full text Add to dashboard Cite

show abstract

Endoscopic Endonasal Surgery in Recurrent and Residual Pituitary Adenomas after Microscopic Resection

Cited by 10 publications

References 0 publications

Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas: institutional experience and predictors of extent of resection

Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas: institutional experience and predictors of extent of resection

Prognostic factors obtained from long-term follow-up of pituitary adenomas and other sellar tumors

Postsurgical Salvage Radiosurgery for Nonfunctioning Pituitary Adenomas Touching/Compressing the Optic Chiasm: Median 13-Year Postirradiation Imaging Follow-up Results

Contact Info

Product

Resources

About