Surgical management of giant pituitary neuroendocrine tumors: Meta-analysis and consensus statement on behalf of the EANS skull base section

Cossu, Giulia; Jouanneau, Emmanuel; Maria, Cavallo Luigi; Froelich, Sébastien; Starnoni, Daniele; Giammattei, Lorenzo; Harel, Ethan; Mazzatenta, Diego; Bruneau, Michaël; Meling, Torstein R.; Berhouma, Moncef; George, Chacko Ari; F, Cornelius Jan; Paraskevopoulos, Dimitrios; Henry, W.S. Schroeder; Idoya, Zazpe; Manet, Romain; Paul, A. Gardner; Dufour, Henry; Cappabianca, Paolo; Thomas, Daniel Roy; Messerer, Mahmoud

doi:10.1016/j.bas.2022.100878

Cited by 15 publications

(13 citation statements)

References 54 publications

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“…Tumor size and invasion of surrounding structures remain the important factors in the prediction of the extent of resection. Large PAs (L-PAs) are defined as tumors with a maximal diameter of ≥30 mm, while giant PAs (G-PAs) are tumors with a maximal diameter of ≥40 mm (5)(6)(7). These tumors account for 6%-10% of PAs in recent surgical series (3,8).…”

Section: Introductionmentioning

confidence: 99%

“…The main factors that will influence the extent of resection with large and giant lesions are the invasion of the cavernous sinus ( 7 , 18 , 19 ), the invasion of the subarachnoid space with encasement of the arteries of Willis circle, the optic/oculomotor nerves in their cisternal portion, and last but not the least, the consistency of the adenoma ( 10 , 17 , 20 , 21 ). Although intuitive, tumor shape plays an important role, as tumors with a multicompartmental morphology and invasion of neurovascular with structures still represent a surgical challenge when compared with tumors of similar size but with a more regular shape.…”

Section: Introductionmentioning

confidence: 99%

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Relationship with the diaphragm to predict the surgical outcome in large and giant pituitary adenomas

et al. 2022

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ObjectiveLarge and giant pituitary adenomas (L- and G-PAs) continue to remain a surgical challenge. The diaphragm may have a role in determining the shape of the tumor and therefore influencing the extent of resection. Our study aims to analyze our surgical series of L- and G-PAs according to their relationship with the diaphragm and invasion of cavernous sinus (CS).Material and methodsWe performed a retrospective analysis of our surgical series of patients operated for L- and G-PAs. We categorized the tumors into four grades according to their relationship with the diaphragm: grade 1 (supradiaphragmatic component with a wide incompetent diaphragm), grade 2 (purely infra-diaphragmatic tumor with a competent diaphragm), grade 3 (dumbbell-shape tumors), and grade 4 (multilobulated tumor with invasion of the subarachnoid space).ResultsA total of 37 patients were included in our analysis. According to our classification, 43.3% of patients had grade 1 tumors, 27% had grade 2, 5.4% had grade 3, and 24.3% had grade 4 tumors. CS invasion was confirmed intraoperatively in 17 out of 37 patients (46%). The gross total resection (GTR) was obtained in 19% of the cases, near-total resection in 46%, and subtotal resection in 35%. All the patients who achieved GTR had grade 1 tumors and the lowest rate of CS invasion (p < 0.01).ConclusionRadiological evaluation of the tumor relationship with the diaphragm, invasion of CS, and invasion of the subarachnoid space are crucial to plan the surgical strategy and maximize the possibilities of achieving GTR in L- and G-PAs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relationship with the diaphragm to predict the surgical outcome in large and giant pituitary adenomas

et al. 2022

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“…8 A recent meta-analysis by the European Association of Neurosurgical Societies skull base section found a rapidly decreasing number of cranial approaches in the past decades (2000-2010: 25%, 2016-2020: 1%) and recommendation of an endoscopic transsphenoidal approach as a first-line option. 9 Not including cranial approach or medically managed patients seems reasonable to us as long as a consecutive series of transsphenoidal patients was included. D'Onofrio et al also suggested that microscopic and endoscopic approaches might be used in specific situations at different centers.…”

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confidence: 99%

In Reply: A Multicenter, Propensity Score-Matched Assessment of Endoscopic Versus Microscopic Approaches in the Management of Pituitary Adenomas

Findlay,

Drexler,

Karsy

2023

Neurosurgery

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“…As pituitary neuroendocrine tumors (pitNETs, formerly known as pituitary adenomas) grow into the suprasellar and parasellar compartments, their surgical management becomes progressively more challenging. 2 Successful transsphenoidal resection of pitNETs is highly associated with several morphological and pathological variables, including tumor size, consistency, invasion of the medial or superior walls of the cavernous sinus (CS), marked lateral extension or encasement of arteries in the subarachnoid space, and surgeon experience. [3][4][5][6][7][8][9] An important factor determining the feasibility of suprasellar component of pituitary macroadenomas is the relation of the tumor to the diaphragma sellae and the width of the aperture of the diaphragma that allows supradiaphragmatic extension of these tumors.…”

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confidence: 99%

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confidence: 99%

Morphological Classification of Pituitary Tumors With Suprasellar Extension

Sarkar,

Corrales,

Laws

et al. 2023

Neurosurgery

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BACKGROUND AND OBJECTIVES: The objective of this study was to study the association among various morphological parameters and surgical outcomes in pituitary macroadenomas with suprasellar extension. METHODS: MRI studies of 160 patients undergoing endoscopic transsphenoidal resection of pituitary macroadenomas with suprasellar extension were reviewed. In the coronal plane, tumors were classified into Type 1 (dome-shaped, no constriction at the level of diaphragma sellae) and Type 2 (dumbbell-shaped, with constriction at the level of diaphragma sellae). Based on the dome-to-neck ratio (D/Nr), Type 2 tumors were further classified as Type 2A (wide neck; D/Nr >1 and <1.3) and Type 2B (narrow neck; D/Nr ≥1.3). Surgical outcomes and complications were analyzed using a logistic regression model. Overall extent of resection (EOR) and presence of residual sellar-suprasellar tumor was separately assessed in all patients with available postoperative MRI (n = 149). RESULTS: There were 108 Type 1 tumors and 26 patients each in the Type 2A and Type 2B subgroups. Tumor subtype was significantly associated with tumor size (P < .001), intraoperative cerebrospinal fluid leak (P < .001), EOR (P < .001), postoperative suprasellar residual tumor (P < .001), and postoperative complications, including diabetes insipidus (P = .005) and visual worsening (P = .003). On multivariate analysis, after adjusting for confounders, Type 2B tumors were negatively associated with EOR (odds ratio [OR] 0.22; 95% CI 0.07-0.68; P = .008) and associated with the presence of postoperative suprasellar residual tumor (OR 18.08; 95% CI 5.20-62.89; P < .001), intraoperative cerebrospinal fluid leak (OR 5.33; 95% CI 1.89-14.99; P = .002), and postoperative diabetes insipidus (OR 4.89; 95% CI 1.67-14.35; P < .001). CONCLUSION: Preoperative tumor classification based on D/Nr is clinically and surgically relevant, and Type 2B macroadenomas are significantly associated with lower rates of gross total resection and higher rates of postoperative complications after endoscopic transsphenoidal resection.

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Surgical management of giant pituitary neuroendocrine tumors: Meta-analysis and consensus statement on behalf of the EANS skull base section

Cited by 15 publications

References 54 publications

Relationship with the diaphragm to predict the surgical outcome in large and giant pituitary adenomas

Relationship with the diaphragm to predict the surgical outcome in large and giant pituitary adenomas

In Reply: A Multicenter, Propensity Score-Matched Assessment of Endoscopic Versus Microscopic Approaches in the Management of Pituitary Adenomas

Morphological Classification of Pituitary Tumors With Suprasellar Extension

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