Outcomes of Surgically Treated Giant Pituitary Tumours

Abstract

446Giant pituitary tumours (GPTs) are rare tumours of 30 mm or more, that have major extensions into the suprasellar and parasellar compartments. [1][2][3][4][5][6][7] Despite the major neurosurgical challenge that resecting GPTs presents, [8][9][10][11][12][13][14][15][16] both transsphenoidal and transcranial approaches have been used. 2,17,18 Transsphenoidal approaches offer a more direct route to the sellar components and can stay outside the arachnoid whenever possible. Transcranial approaches offer direct visualization of the suprasellar components but, because they must come from the subarachnoid position, visualizing the sellar contents can be difficult without drilling the planum sphenoidale or mobilizing the optic nerve.Surgical morbidity and mortality for these lesions can be high, although the safety of the surgery has progressively ABSTRACT: Objective: To evaluate the outcomes of patients with giant pituitary tumours (GPTs) who underwent a purely binasal endoscopic transsphenoidal surgery (BETS) and compare their outcomes with those achieved through craniotomy and microscopic transsphenoidal surgery (MTS). Methods: Seventy-two consecutive patients with GPTs (greater than 10 cm 3 in volume) who were treated surgically with BETS, craniotomy, or MTS from October 1994 to July 2009 were reviewed for clinical outcomes, degree of tumor resection, recurrence rates, and surgical complications. Results: The BETS group had significantly better mean reduction of tumor volume (91%) than the craniotomy (63%, p = 0.001), and the MTS (63%, p = 0.010) groups. Gross total resection rates were also higher for BETS patients than for craniotomy patients (p = 0.010). Improvements in vision and headaches were noted in 96% and 100% of patients in the BETS group, respectively; these rates were similar to those in the craniotomy and MTS groups. Of the four patients with hormone-secreting tumours in the BETS group, three remained in remission. The median length-of-stay (four days) for the BETS group was shorter (p = 0.010), and surgical complications were less frequent (p = 0.037) and less severe compared to the craniotomy group. There were no differences in the recurrence rates: 79% percent of patients in the BETS group, 69% in the craniotomy group, and 79% in the MTS group were recurrence free at last follow-up (p = 0.829). Conclusions: Treatment of GPT with BETS offers excellent oncologic and clinical outcomes and can frequently obviate the need for craniotomy in these patients. RÉSUMÉ: Résultats du traitement chirurgical des tumeurs géantes de l'hypophyse (TGH).Objectif : Le but de l'étude était d'évaluer les résultats de la chirurgie transsphénoïdale endoscopique binasale (CTEB), de la craniotomie et de la chirurgie transsphénoïdale par microscopie (CTM) chez des patients atteints de tumeurs géantes de l'hypophyse et de comparer les résultats obtenus suite à ces chirurgies. Méthode : Les dossiers de patients consécutifs atteints de TGH (volume supérieur à 10 cm3), qui ont été traités chirurgicalement soit par CTEB, crani...

Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications

“…Complete resection is often a technical challenge, even for experienced neurosurgeons, considering that this subgroup of tumors may present with a high degree of invasion of neurovascular structures and large areas of supra-and parasellar extension 11,23 . In this way, the primary objective of surgery includes relief of mass effect by obtaining maximal tumor resection in order to decompress visual pathways, neurovascular structures and the pituitary gland 6,9,15 .…”

“…It is worth emphasizing that only one purely endoscopic surgical series was included in their analysis, since the manuscript by de Paiva Neto et al 24 was mainly microscopic transphenoidal. Thereafter, few studies came out in the literature addressing the outcomes of patients undergoing resection for large and giant pituitary adenomas by the endoscopic approach 6,8,10,11,13,14,15,16 . Their main surgical outcomes and complications rates are detailed on Tables 3 and 4 …”

“…There is no consensus, however, on the definition of large pituitary adenomas 8,9 . Juraschka et al 10 have considered large tumors as those having > 3 cm in the maximal diameter, while Cusimano et al 11 have introduced a new volumetric assessment (≥ 10 cm 3 ) on the assumption of a better estimation of the tumor size and also for a better quantification of the extent of resection.…”

“…Traditionally, these tumors have been handled by the transcranial route, alone or in combination with the transsphenoidal resection 7,9,11,12 . Some recent reports have described the usefulness of the endoscopic endonasal route in the their management, even though its safety and effectiveness of treating large and giant pituitary adenomas is yet to be established in the literature 6,8,10,11,13,14,15,16 .…”

“…Some recent reports have described the usefulness of the endoscopic endonasal route in the their management, even though its safety and effectiveness of treating large and giant pituitary adenomas is yet to be established in the literature 6,8,10,11,13,14,15,16 . Herein, we sought to investigate our institutional experience of patients who underwent endoscopic endonasal transsphenoidal approach for treatment of large and giant pituitary adenomas emphasizing the surgical results and approachrelated complications.…”