Intrasellar pressure and tumor volume in pituitary tumor: relation study

Abstract

-Objective: To determine if there was a relationship between intrassellar pressure (ISP) and p i t u i t a ry tumor volume. Method: Between August 2002 and May 2004, 60 patients aged between 13 and 75 years old (39 males), having a pituitary adenoma were submitted to an endoscope transseptal appro a c h . During the surg e ry and before tumor resection, 2 mm of the sella's floor were removed and a 1.5 mm dural opening made to place a transducer into the pituitary adenoma. The transducer was connected to a p re s s u re monitor. Results: The intrasellar pre s s u re, ranged from 2-51 mmHg and was measured based on the classification of Hard y -Vezina. The most elevated was in the type II macro adenomas with 32.6 mmHg, sharply superior to the value of a normal intracranial pre s s u re . Conclusion: These values showed that the m a c roadenomas confined to the sella, without destruction of the floor and integrity of the diaphragm, type II of Hardy-Vezina, presented a value of ISP much higher than intra-extrasellar macroadenoma's.KEY WORDS: pituitary adenoma, intrasellar pressure, endonasal approach. Relação entre pressão intra-selar e volume de tumor de hipófiseObjetivo: Determinar se existia uma relação entre a pressão intraselar (ISP) e o volume de tumor de hipó-f i s e . Método: E n t re agosto de 2002 e maio de 2004, 60 pacientes com idades variando entre 13 e 75 anos (39 homens), port a d o res de adenoma hipofisários foram operados por via transesfenoidal. Durante o ato c i r ú rgico e antes da resseção do tumor, uma osteotomia de 2 mm foi realizada no assoalho selar e uma a b e rtura de 1,5 mm na duramater para a introdução de um transdutor dentro do tumor. O transdutor foi conectado a um monitor de pressão e esta foi medida por 2 minutos. Resultados: A pressão intra-selar variou entre 2-51 mmHg e a correlação entre tamanho do tumor e ISP foi baseada na classificação de Hard yVezina. A média da ISP mais elevada foi encontrada nos macroadenomas tipo II com 32,6 mmHg, nitidamente superior a pressão intra selar norm a l . Conclusão: Estes valores mostram que os macro a d e n o m a s confinados a sela sem destruição do assoalho selar e com integridade do diafragma, classificados como tipo II de Hardy-Vezina, apresentam uma ISP muito superior aos outros adenomas. PALAVRAS-CHAVE: adenoma hipofisário, pressão intra-selar, via transesfenoidal.T h e re are studies in the literature corre l a t i n g intrasellar pre s s u re(ISP) and adenoma blood flow 1 , ISP and stalk compression syndrome 2 , ISP and endocrine function 3 , 4 , ISP and headaches 3 , pituitary volume and headache 5 , ISP and pituitary tumor apop l e x y 6 , but there are no specific studies corre l a t i n g ISP and tumor volume.The walls of the sella turcica are a relatively rigid s t ru c t u reand under normal circumstances, may serv e to protect the pituitary gland from trauma and surrounding pressure fluctuations. The growth of a tumor within the sella, a normally inelastic space, is likely to cause an increase of ISP. It has been conje...

Significant improvement of intractable headache after transsphenoidal surgery in patients with pituitary adenomas; preoperative neuroradiological evaluation and intraoperative intrasellar pressure measurement

“…Gondim et al studied the statistical associations between presence of headache and tumor size, optic compression, sellar destruction and cavernous sinus invasion, concluding an association between tumor extension and symptom severity [3,12]. However, in that study, the majority of the patients (81.2%) had macroadenoma and a large mean tumor size of 24.6 ± 15.1mm [8].…”

“…Briefly, the procedure was as follows [12,13]: an incision was made through bone and dura to admit the sensor into the adenoma. The length of these incisions was 3 mm.…”

Mean intrasellar pressure, visual field, headache intensity and quality of life of patients with pituitary adenoma

“…discussion There are other published series of patients that had its ISP monitored 4,[7][8][9][10][11][12][13][14][15][16] . The difficulty with this subject is, Table 3.…”

“…The headache and the hormonal disturbance are among the factors that contribute to worsen the quality of life in a large number of patients 6 . The relationship between increased ISP, visual changes and headache was object of studies in recent years 4,[7][8][9][10][11][12][13][14][15] , including in Brazil 16 . However, none of these evaluations used scales for assessing the quality of life and severity of headache in patients with pituitary adenomas.…”

Clinical and laboratorial characterization and post-surgical follow-up of 87 patients with non-functioning pituitary macroadenomas

“…The immediate relief achieved through surgery seems to be directly related to the reduced intratumoral pressure [30][31][32] . In our sample, this was achieved through reduction of tumor volume and, more exceptionally, tumor exclusion.…”