Large and giant pituitary adenoma resection by microscopic trans-sphenoidal surgery: Surgical outcomes and complications in 123 consecutive patients

Karki, Mohan; Sun, Jinzhang; Yadav, Chandra Prakash; Zhao, Bing

doi:10.1016/j.jocn.2017.07.015

Cited by 29 publications

(17 citation statements)

References 19 publications

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“…As pituitary adenomas enlarge, they have the potential to compress the optic chiasm, optic nerves, carotid arteries, and the pituitary gland. 10 Compression of any of these structures can present with visual disturbances, ophthalmoplegia, endocrine dysfunction, and many other symptoms. 10 In a mechanism similar to that of pituitary apoplexy, rapid compression of adjacent structures is responsible for the clinical presentation.…”

Section: Discussionmentioning

confidence: 99%

“…10 Compression of any of these structures can present with visual disturbances, ophthalmoplegia, endocrine dysfunction, and many other symptoms. 10 In a mechanism similar to that of pituitary apoplexy, rapid compression of adjacent structures is responsible for the clinical presentation. Larger pituitary adenomas, therefore, pose a greater threat to compress adjacent structures and more often present with more significant symptomology.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Outcomes of Pituitary Gland Preservation in Pituitary Macroadenoma Apoplexy: Case Series and Review of the Literature

Souter

Jusué-Torres

Grahnke

et al. 2019

J Neurol Surg B Skull Base

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Introduction For patients presenting with neurological changes from pituitary tumor apoplexy, urgent surgical intervention is commonly performed for diagnosis, tumor resection, and optic apparatus decompression. Although identification and preservation of the pituitary gland during the time of surgery can be challenging, it may lead to improve endocrine outcomes. Methods A retrospective case series of all patients with macroadenomas presenting with apoplexy at Loyola University Medical Center from 2016 to 2018 was studied. Demographic, radiographic, and intraoperative characteristics were collected including age, gender, comorbidities, presenting symptoms, preoperative size of pituitary adenoma, Knosp's grade, Hardy's grade, identification and/or preservation of the gland, pre- and postoperative hormonal levels, intraoperative and/or postoperative complications, and follow-up time. Results A total of 68 patients underwent endoscopic endonasal surgery for resection of a macroadenoma. Among them, seven (10.2%) presented with apoplexy; five patients were male and two were female and presenting symptoms and signs included headache (100%), endocrinopathies (57%), visual acuity deficit (71%), visual field deficit (71%), and oculomotor palsy (57%). A gross-total resection rate was achieved in 86% of patients. Among them, 71% of patients obtained complete symptomatic neurological improvement. A statistically significant difference between gender and endocrine function was found, as no females and all males required some form of postoperative hormonal supplementation (p = 0.047). Conclusion Endoscopic endonasal resection of macroadenomas with sparing of the pituitary gland in the setting of apoplexy is safe and effective. Preservation of the normal gland led to no posterior pituitary dysfunction, and a statistically significant difference between gender and postoperative endocrinopathy was identified. Further studies with larger samples sizes are warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Pituitary Gland Preservation in Pituitary Macroadenoma Apoplexy: Case Series and Review of the Literature

Souter

Jusué-Torres

Grahnke

et al. 2019

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

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“…9 Karki et al. 10 reported that resection of large and giant pituitary adenomas by transsphenoidal surgery was safe and efficient and had low morbidity and mortality. Gaillard 11 stated that the use of an endoscope created a much larger workspace and better visualization compared with a microscope.…”

Section: Discussionmentioning

confidence: 99%

Difference in the incidence of cerebrospinal fluid leakage and residual tumors between functional and nonfunctional pituitary adenomas treated by endoscopic transsphenoidal pituitary adenomectomy

et al. 2019

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ObjectiveThis study compared the incidence of cerebrospinal fluid (CSF) leakage and residual tumors between functional and nonfunctional pituitary adenomas treated with the endoscopic endonasal transsphenoidal approach (EETA).MethodsAll patients underwent endocrine examinations and brain magnetic resonance imaging before and after surgery. The length of admission, incidence of central diabetes insipidus, incidence of CSF leakage, symptom relief, and presence of residual tumors were compared between patients with functional and nonfunctional pituitary adenomas.ResultsThirty-eight patients were enrolled, among whom 12 and 26 had functional and nonfunctional pituitary adenomas, respectively. The incidence of CSF leakage was significantly higher in patients with nonfunctional adenomas; a hard or elastic tumor character accounted for the difference. A large tumor size and cavernous sinus invasion were risk factors for residual tumors. No significant differences were found in sex, length of admission, operative times, incidence of diabetes insipidus, or number of residual tumors between the two groups. The hormone levels were lower postoperatively than preoperatively in patients with nonfunctional adenomas.ConclusionNonfunctional pituitary macroadenomas resulted in more CSF leakage. Use of the rescue nasoseptal flap reduced unnecessary nasal destruction. Cooperation between a neurosurgeon and otolaryngologist was safer and more effective when using the EETA.

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“…Its main clinical manifestations are progressive growth of tumors or acute hemorrhage of tumors squeezing normal pituitary gland, resulting in abnormal secretion of glandular hormones, which leads to hyperprolactinemia, acromegaly, Cushing syndrome, etc . The treatment of pituitary adenoma includes surgical resection, radiotherapy and chemotherapy . Postoperative recurrence of pituitary adenoma is still possible .…”

Section: Introductionmentioning

confidence: 99%

Reduction of miR‐212 contributes to pituitary adenoma cell invasion via targeting c‐Met

Wang

Gao

2019

The Kaohsiung J of Med Scie

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The current study aimed to evaluate the expression and role of miR-212 in the progression of pituitary adenoma (PA), thereby providing a theoretical basis and potential therapy methods for PA patients. Our data showed that miR-212 levels were significantly reduced in PA tissues than normal pituitary tissues. However, no significant difference was identified in the serum of PA patients and healthy control. In addition, the expression of miR-212 in invasive PA was significantly lower than that in noninvasive and normal pituitary tissues. Moreover, the level of miR-212 was decreased with the increase of tumor invasion. Meanwhile, the expression of miR-212 in giant adenomas was significantly lower than that in macroadenomas and microadenomas. Furthermore, inhibition of miR-212 significantly enhanced the proliferation and invasive capacity of GH3 cells. Dual luciferase reporter assay and western blot analysis confirmed that c-Met was a target gene of miR-212. More importantly, upregulation of c-Met significantly prompted PA cell proliferation mainly as a result of the enhanced level of phosphorylation of AKT. This effect could be abolished when c-Met was silenced in GH3 cells. In summary, reduced miR-212 expression in PA contributed to abnormal cancer cell proliferation and invasion mainly by targeting c-Met.

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Large and giant pituitary adenoma resection by microscopic trans-sphenoidal surgery: Surgical outcomes and complications in 123 consecutive patients

Cited by 29 publications

References 19 publications

Long-Term Outcomes of Pituitary Gland Preservation in Pituitary Macroadenoma Apoplexy: Case Series and Review of the Literature

Long-Term Outcomes of Pituitary Gland Preservation in Pituitary Macroadenoma Apoplexy: Case Series and Review of the Literature

Difference in the incidence of cerebrospinal fluid leakage and residual tumors between functional and nonfunctional pituitary adenomas treated by endoscopic transsphenoidal pituitary adenomectomy

Reduction of miR‐212 contributes to pituitary adenoma cell invasion via targeting c‐Met

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