Shigetoshi Yano1, Takuichiro Hide2, Naoki Shinojima2. 1. Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University Graduate School, Kumamoto, Japan. Electronic address: yanos@kumamoto-u.ac.jp. 2. Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University Graduate School, Kumamoto, Japan.
Abstract
OBJECTIVE: We report surgical results and complications of endoscopic endonasal skull base surgery for giant pituitary adenomas. METHODS: This study included 34 pituitary adenomas >40 mm treated by endoscopic endonasal skull base surgery between 2002 and 2015. Removal rates, symptoms, and complications were analyzed by direction of tumor extension. RESULTS: Average tumor size was 45.5 mm. Near-total resection was achieved in 16 of 34 (47.1%) cases. Near-total resection was achieved significantly more often in anterior extension types and round tumor in superior extension types compared with multiple extension types. The average residual amount in 18 partial resection cases was 30.2% of preoperative volume, with no significant difference between groups. Regrowth after partial resection occurred in 8 cases, but repeated surgery or stereotactic radiotherapy controlled tumor growth and improved symptoms. Postoperative improvement of visual field deficits was achieved in 23 of 25 (92.0%) cases. Postoperative complications included visual deterioration (n = 1), cerebrospinal fluid leakage (n = 2), and cerebral infarction secondary to perforator injury (n = 2). Symptomatic intratumoral hemorrhage occurred in 1 multiple extension type. CONCLUSIONS: Endoscopic endonasal skull base surgery enables less invasive and safer removal of various extension types of giant pituitary adenomas. Preservation of visual function is essential. Two-stage surgery or partial resection with additional treatments is possible without complications if a sufficient amount of resection is performed. In cases in which insufficient resection may be expected, alternative treatment, including combined-simultaneous resection, should be considered.
OBJECTIVE: We report surgical results and complications of endoscopic endonasal skull base surgery for giant pituitary adenomas. METHODS: This study included 34 pituitary adenomas >40 mm treated by endoscopic endonasal skull base surgery between 2002 and 2015. Removal rates, symptoms, and complications were analyzed by direction of tumor extension. RESULTS: Average tumor size was 45.5 mm. Near-total resection was achieved in 16 of 34 (47.1%) cases. Near-total resection was achieved significantly more often in anterior extension types and round tumor in superior extension types compared with multiple extension types. The average residual amount in 18 partial resection cases was 30.2% of preoperative volume, with no significant difference between groups. Regrowth after partial resection occurred in 8 cases, but repeated surgery or stereotactic radiotherapy controlled tumor growth and improved symptoms. Postoperative improvement of visual field deficits was achieved in 23 of 25 (92.0%) cases. Postoperative complications included visual deterioration (n = 1), cerebrospinal fluid leakage (n = 2), and cerebral infarction secondary to perforator injury (n = 2). Symptomatic intratumoral hemorrhage occurred in 1 multiple extension type. CONCLUSIONS: Endoscopic endonasal skull base surgery enables less invasive and safer removal of various extension types of giant pituitary adenomas. Preservation of visual function is essential. Two-stage surgery or partial resection with additional treatments is possible without complications if a sufficient amount of resection is performed. In cases in which insufficient resection may be expected, alternative treatment, including combined-simultaneous resection, should be considered.
Authors: Avital Perry; Christopher Salvatore Graffeo; Christopher Marcellino; Bruce E Pollock; Nicholas M Wetjen; Fredric B Meyer Journal: J Neurol Surg B Skull Base Date: 2018-01-24
Authors: Emma M H Slot; Rengin Sabaoglu; Eduard H J Voormolen; Eelco W Hoving; Tristan P C van Doormaal Journal: J Neurol Surg B Skull Base Date: 2021-08-20
Authors: John T Butterfield; Takako Araki; Daniel Guillaume; Ramachandra Tummala; Emiro Caicedo-Granados; Matthew A Tyler; Andrew S Venteicher Journal: J Neurol Surg B Skull Base Date: 2021-02-22
Authors: Daniel J Lobatto; Friso de Vries; Amir H Zamanipoor Najafabadi; Alberto M Pereira; Wilco C Peul; Thea P M Vliet Vlieland; Nienke R Biermasz; Wouter R van Furth Journal: Pituitary Date: 2018-02 Impact factor: 4.107
Authors: David P Bray; Sai Mannam; Rima S Rindler; Joseph W Quillin; Nelson M Oyesiku Journal: Front Endocrinol (Lausanne) Date: 2022-08-04 Impact factor: 6.055
Authors: Giulia Cossu; Emmanuel Jouanneau; Luigi M Cavallo; Sebastien Froelich; Daniele Starnoni; Lorenzo Giammattei; Ethan Harel; Diego Mazzatenta; Micheal Bruneau; Torstein R Meling; Moncef Berhouma; Ari G Chacko; Jan F Cornelius; Dimitrios Paraskevopoulos; Henry W S Schroeder; Idoya Zazpe; Romain Manet; Paul A Gardner; Henry Dufour; Paolo Cappabianca; Roy T Daniel; Mahmoud Messerer Journal: Brain Spine Date: 2022-03-28