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Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations.
J Neurosurg 2013; 118(3):621-31JN

Abstract

OBJECT

Giant pituitary adenomas (> 4 cm in maximum diameter) represent a significant surgical challenge. Endoscopic endonasal surgery (EES) has recently been introduced as a treatment option for these tumors. The authors present the results of EES for giant adenomas and analyze the advantages and limitations of this technique.

METHODS

The authors retrospectively reviewed the medical files and imaging studies of 54 patients with giant pituitary adenomas who underwent EES and studied the factors affecting surgical outcome.

RESULTS

Preoperative visual impairment was present in 45 patients (83%) and partial or complete pituitary deficiency in 28 cases (52%), and 7 patients (13%) presented with apoplexy. Near-total resection (> 90%) was achieved in 36 patients (66.7%). Vision was improved or normalized in 36 cases (80%) and worsened in 2 cases due to apoplexy of residual tumor. Significant factors that limited the degree of resection were a multilobular configuration of the adenoma (p = 0.002) and extension to the middle fossa (p = 0.045). Cavernous sinus invasion, tumor size, and intraventricular or posterior fossa extension did not influence the surgical outcome. Complications included apoplexy of residual adenoma (3.7%), permanent diabetes insipidus (9.6%), new pituitary insufficiency (16.7%), and CSF leak (16.7%, which was reduced to 7.4% in recent years). Fourteen patients underwent radiation therapy after EES for residual mass or, in a later stage, for recurrence, and 10 with functional pituitary adenomas received medical treatment. During a mean follow-up of 37.9 months (range 1-114 months), 7 patients were reoperated on for tumor recurrence. Three patients were lost to follow-up.

CONCLUSIONS

Endoscopic endonasal surgery provides effective initial management of giant pituitary adenomas with favorable results compared with traditional microscopic transsphenoidal and transcranial approaches.

Authors+Show Affiliations

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Studies
Journal Article

Language

eng

PubMed ID

23289816

Citation

Koutourousiou, Maria, et al. "Endoscopic Endonasal Surgery for Giant Pituitary Adenomas: Advantages and Limitations." Journal of Neurosurgery, vol. 118, no. 3, 2013, pp. 621-31.
Koutourousiou M, Gardner PA, Fernandez-Miranda JC, et al. Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations. J Neurosurg. 2013;118(3):621-31.
Koutourousiou, M., Gardner, P. A., Fernandez-Miranda, J. C., Paluzzi, A., Wang, E. W., & Snyderman, C. H. (2013). Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations. Journal of Neurosurgery, 118(3), pp. 621-31. doi:10.3171/2012.11.JNS121190.
Koutourousiou M, et al. Endoscopic Endonasal Surgery for Giant Pituitary Adenomas: Advantages and Limitations. J Neurosurg. 2013;118(3):621-31. PubMed PMID: 23289816.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations. AU - Koutourousiou,Maria, AU - Gardner,Paul A, AU - Fernandez-Miranda,Juan C, AU - Paluzzi,Alessandro, AU - Wang,Eric W, AU - Snyderman,Carl H, Y1 - 2013/01/04/ PY - 2013/1/8/entrez PY - 2013/1/8/pubmed PY - 2013/4/23/medline SP - 621 EP - 31 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 118 IS - 3 N2 - OBJECT: Giant pituitary adenomas (> 4 cm in maximum diameter) represent a significant surgical challenge. Endoscopic endonasal surgery (EES) has recently been introduced as a treatment option for these tumors. The authors present the results of EES for giant adenomas and analyze the advantages and limitations of this technique. METHODS: The authors retrospectively reviewed the medical files and imaging studies of 54 patients with giant pituitary adenomas who underwent EES and studied the factors affecting surgical outcome. RESULTS: Preoperative visual impairment was present in 45 patients (83%) and partial or complete pituitary deficiency in 28 cases (52%), and 7 patients (13%) presented with apoplexy. Near-total resection (> 90%) was achieved in 36 patients (66.7%). Vision was improved or normalized in 36 cases (80%) and worsened in 2 cases due to apoplexy of residual tumor. Significant factors that limited the degree of resection were a multilobular configuration of the adenoma (p = 0.002) and extension to the middle fossa (p = 0.045). Cavernous sinus invasion, tumor size, and intraventricular or posterior fossa extension did not influence the surgical outcome. Complications included apoplexy of residual adenoma (3.7%), permanent diabetes insipidus (9.6%), new pituitary insufficiency (16.7%), and CSF leak (16.7%, which was reduced to 7.4% in recent years). Fourteen patients underwent radiation therapy after EES for residual mass or, in a later stage, for recurrence, and 10 with functional pituitary adenomas received medical treatment. During a mean follow-up of 37.9 months (range 1-114 months), 7 patients were reoperated on for tumor recurrence. Three patients were lost to follow-up. CONCLUSIONS: Endoscopic endonasal surgery provides effective initial management of giant pituitary adenomas with favorable results compared with traditional microscopic transsphenoidal and transcranial approaches. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/23289816/Endoscopic_endonasal_surgery_for_giant_pituitary_adenomas:_advantages_and_limitations_ L2 - https://thejns.org/doi/10.3171/2012.11.JNS121190 DB - PRIME DP - Unbound Medicine ER -