Craniocaudal Extension as an Indication of Surgical Outcome in Transsphenoidal Surgery for Pituitary Adenomas

Hamid, Osama; Hakim, Adel El; Husseiny, Hossam El; Fiky, Lobna El; Kamel, Sherif Galal

doi:10.1007/s12070-011-0350-3

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…A volumetric threshold greater than 10 cm 3 was found for lesions that demonstrated high perioperative morbidity and a high rate of subtotal resection following endonasal endoscopic surgery. 18 The tumor characteristics that are independent predictors of subtotal resection include significant vertical intracranial extension, 15,19,42 irregular and multilobular configuration, fibrous and firm consistency, 29,30 and cavernous sinus invasion.…”

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confidence: 99%

Pituitary macroadenomas with oculomotor cistern extension and tracking: implications for surgical management

Hoang¹,

Tran²,

Herde

et al. 2016

JNS

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T reaTmenT management strategies for pituitary macroadenomas depend on numerous factors that guide the determination of medical management, surgical approach, and/or adjuvant therapeutic options. Maximal resection and adequate decompression of the neurological structures is the paradigm of care for symptomatic pituitary macroadenomas, with the exception of medically responsive prolactinomas.Since its inception by Schloffer in 1907 and then refinement and popularization by Hirsch, Guiot, and Hardy, the transsphenoidal approach has become the preferred route to the sella because of its relative safety profile. 9,14,16,17 The transcranial route still plays an important role in providing access to the sella in 1% to 4% of pituitary macroadenomas where direct visualization and accessibility via the transsphenoidal approach are limited. 38A transcranial approach should be considered in the surgical management of pituitary adenomas that display constriction at the diaphragma sellae, parasellar extension or inaccessible suprasellar extension off the midline, tumors of fibrous consistency with large suprasellar extension, and in patients with an active sinus infection or a coexisting adjacent aneurysm. Other cases that should be approached transcranially include those patients with ectatic intrasellar carotid arteries, 40 retrosellar extension, brain invasion with edema, involvement or vasospasm of the arteries of the circle of Willis, or encasement of the optic apparatus or invasion of the optic foramina. obJective Oculomotor cistern extension of pituitary adenomas is an overlooked feature within the literature. In this study, 7 cases of pituitary macroadenoma with oculomotor cistern extension and tracking are highlighted, and the implications of surgical and medical management are discussed. methods The records of patients diagnosed with pituitary macroadenomas who underwent resection and in whom preoperative pituitary protocol MRI scans were available for review were retrospectively reviewed. The patient and tumor characteristics were reviewed along with the operative outcomes and complications. results Seven patients (4.1%) with oculomotor cistern extension and tracking were identified in a cohort of 170 patients with pituitary macroadenoma. The most common presenting symptoms were visual deficit (6 patients; 86%), apoplexy (3 patients; 43%), and oculomotor nerve palsy (3 patients; 43%). Lone oculomotor nerve palsy was seen in 2 patients without apoplexy and 1 patient with an apoplectic event. Gross-total resection was achieved via a microscopic endonasal transsphenoidal approach with or without endoscopic aid to the sella in 14%, near-total resection in 29%, and subtotal resection in 57% of patients in the data set. coNclusioNs Pituitary adenoma extension along the oculomotor cistern is uncommon; however, preoperatively recognizing such extension should play an important role in the surgeon's operative considerations and postoperative clinical management because this extension can limit gross-total resection using t...

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mentioning

confidence: 99%

Pituitary macroadenomas with oculomotor cistern extension and tracking: implications for surgical management

Hoang¹,

Tran²,

Herde

et al. 2016

JNS

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“…The present study ascertains that there is significant correlation between the cranio-caudal diameter of pituitary macro adenoma and changes in visual field. This study will help to build awareness among the colleagues of other disciplines especially the ophthalmologist for early diagnosis of these patients and prompt neurosurgical intervention needed to save vision [16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

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confidence: 99%

Changes in the Visual Field associated with Cranio-caudal Diameter of Pituitary Macro adenoma

KM¹,

Gomes²,

Hasan³

2021

J Can Res Rev Rep

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Background: Pituitary macro adenomas are benign in origin, mass effects of which, may lead to serious clinical symptoms such as visual impairments, chronic headache, and pituitary insufficiency. The visual disturbance in pituitary macro adenomas range from dimness of vision to bilateral total loss of vision. Visual field defect is one of the common presentations of pituitary macro adenomas. They usually results in bitemporal hemianopia by causing compression on optic chiasm. Our main objective of this study was to evaluate the changes of visual field in relation with cranio-caudal diameter of pituitary macro adenoma. Methods and Materials: This cross-sectional, observational study was carried out at Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka from April, 2019 to September, 2020. Thirty six patients with pituitary macro adenomas underwent visual field analysis using Humphrey Field Analyzer30-2 program at Bangabandhu Sheikh Mujib Medical University. Correlation betweenmean deviation of visual field with craniocaudal diameter of pituitary macroadenomas, volume of tumor, duration of sypmtoms were observed. Results: This study was conducted on 67 eyes of 36 patients including 22 male and 14 female subjects with mean age of 39.00 years and histologically proven pituitary adenoma. Mean cranio-caudal diameter was 31.72 mm. Highest number of patients had cranio-caudal diameter of 32-41 mm with mean deviation of -12.95 dB and -12.24dB in right and left eye respectively. Regarding correlation of mean deviation of visual field with cranio-caudal diameter of pituitary macro adenoma, Pearson correlation showed that r value was -0.358(p-value0.044) in right eye and -0.527(p-value 0.012) in left eye. Conclusion: When pituitary macro adenomas grow in vertical direction it results in deterioration of visual field by compressing optic chiasma. The present study ascertains that there is significant correlation between the cranio-caudal diameter of pituitary macro adenoma and deviation visual field.

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Craniocaudal Extension as an Indication of Surgical Outcome in Transsphenoidal Surgery for Pituitary Adenomas

Cited by 2 publications

References 23 publications

Pituitary macroadenomas with oculomotor cistern extension and tracking: implications for surgical management

Pituitary macroadenomas with oculomotor cistern extension and tracking: implications for surgical management

Changes in the Visual Field associated with Cranio-caudal Diameter of Pituitary Macro adenoma

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