Analysis of operative efficacy for giant pituitary adenoma

Abstract

BackgroundSurgical treatment of giant pituitary adenomas is difficult due to complicated dissection of the sellar area. The extent of tumor resection affects the efficacy of surgical treatment. This study is to investigate the efficacy of microsurgical treatment for giant pituitary adenoma and to analyze the relationship between treatment efficacy and tumor resection extent.MethodsA retrospective analysis was performed in 36 patients who received microsurgery to remove giant pituitary adenomas. The sizes of tumors before and after surgery were calculated with a novel method called the “platform-like volume calculation formula”. The relationships between extent of resection and the visual impairment recovery, and improvement of serum hormone level before and after operation were analyzed.ResultsTwo deaths were observed after surgery. And the gross and near-total resection was achieved in 8 cases, subtotal resection in 8 cases, mostly partial resection in 15 cases, and partial resection in 5 cases. The average resection rate was 72.8%. The resection rate of tumor with cavernous sinus invasion was significantly lower than those of patients without cavernous sinus invasion (P < 0.05). The improvement rate of hormone level in functional adenoma was 80.0%. Follow-up observations were carried out for 3 ~ 28 months in 25 cases. Visual improvement was observed in 64.0% of the cases.ConclusionsMicrosurgical treatment can improve the visual impairment of the majority of cases and significantly decrease the serum hormone levels of functional adenoma. The extent of resection was significantly associated with cavernous sinus invasion.

A novel “total pituitary hormone index” as an indicator of postoperative pituitary function in patients undergoing resection of pituitary adenomas

“…In order to reduce the error caused by the impact of the cavernous sinus on the tumor volume after contrast-enhanced scanning, we defined the part between every two planes on the coronal plane of the tumor as an independent frustum. The authors’ previously published [ 39 ] formula for calculating the frustum volume is: V = [S1 + S2 + (S1 + S2)/2] × h/3 = (S1 + S2) × h/2 (S1 and S2 were measured by the INFINITT PACS system). A sample calculation of the tumor area on a single coronary MRI plane is shown in supplemental Figure 1 .…”

Efficacy of sellar opening in the pituitary adenoma resection of transsphenoidal surgery influences the degree of tumor resection

“…As proposed by Wang et al [26] during transsphenoidal surgery, enlargement of surgical scope is likely to induce injury to the neurohypophysis and its blood supply, eventually leading to the incidence of diabetes insipidus.…”

Adenoma Hipofisis

“…Pada beberapa penderita pemberian terapi yang intensif terkadang tidak dilakukan karena akan membuat lesi yang luas pada tumor bila hendak dilakukan reseksi oleh karenanya dipertimbangkan pengobatan terhadap defisiensi hormon dengan tetap melakukan control terhadap tanda, gejala, pemeriksaan darah, dan pemantauan foto roentgen serial. 3,14,15 Tatalaksana untuk tumor hipofisis harus secara komprehensif dan individual, dengan tujuan. 3 efek mekanis pada struktur sekitarnya.…”