Hydrocephalus caused by giant pituitary tumors: case series and guidelines for management

Abstract

Giant pituitary adenomas causing hydrocephalus are rare (Scarone P, Losa M, Mortini P, Giovanelli M. J Neurooncol 2006;76:51-4; Zikel OM, Atkinson JL, Hurley DL. Mayo Clinical Proc 1999;74:475-7). Guidelines for management of this rare condition are missing. Here we present a five-case series collected over 22 years. We suggest that where the two conditions coexist, the safest option is to insert an external ventricular drain prior to any definitive surgical intervention.

Clinical features and management of nonfunctioning giant pituitary adenomas causing hydrocephalus

“…NFGPAs causing hydrocephalus is extremely rare with only 13 cases reported in previous literatures (Table 2 ) and it lacks of guidelines for management in the past years [ 9 – 12 ]. What’s more, conclusions from previous case reports remain inconsistent, especially on the timing of hydrocephalus management and surgical approaches of pituitary adenomas.…”

“…What’s more, conclusions from previous case reports remain inconsistent, especially on the timing of hydrocephalus management and surgical approaches of pituitary adenomas. Four of these adenomas were reported by Joshi et al, who applied transsphenoidal surgery for patients and considered preoperative EVD as necessary to ensure the safety of subsequent operation [ 9 ]. Verhelst et al reported 1 case of NFGPA with hydrocephalus, who underwent preoperative VP shunt and transcranial surgery with unsatisfactory resection.…”

“…A detailed search of Medline using terms “hydrocephalus” and “giant pituitary tumor OR giant pituitary adenoma OR giant hypohysoma” produces only several case reports, with inconsistent conclusions regarding the timing of hydrocephalus management and surgical approaches [ 9 – 13 ]. It was assumed by Laws that pituitary adenomas were usually soft and would descend to intrasellar region, unblocking the third ventricle and rendering presurgical external ventricular drainage (EVD) unnecessary [ 9 ]. Contrastly, Joshi et al and Verhelst et al considered presurgical EVD to be necessary and safe for subsequent surgery [ 9 , 11 ].…”

“…It was assumed by Laws that pituitary adenomas were usually soft and would descend to intrasellar region, unblocking the third ventricle and rendering presurgical external ventricular drainage (EVD) unnecessary [ 9 ]. Contrastly, Joshi et al and Verhelst et al considered presurgical EVD to be necessary and safe for subsequent surgery [ 9 , 11 ]. Most reported cases were operated by the transsphenoidal approach with a low morbidity and mortality, while tumors with dumb-bell-shaped or extensive suprasellar invasions were difficult to resect with endonasal approach and surgeons might turn to transcranial or combined approaches [ 9 , 12 ].…”

“…Contrastly, Joshi et al and Verhelst et al considered presurgical EVD to be necessary and safe for subsequent surgery [ 9 , 11 ]. Most reported cases were operated by the transsphenoidal approach with a low morbidity and mortality, while tumors with dumb-bell-shaped or extensive suprasellar invasions were difficult to resect with endonasal approach and surgeons might turn to transcranial or combined approaches [ 9 , 12 ]. Endoscopy and neuronavigation system have also been described to be helpful in the resection of NFGPAs [ 8 , 12 ].…”