Endoscopic Endonasal Approach for Giant Pituitary Adenoma Occupying the Entire Third Ventricle: Surgical Results and a Review of the Literature

Giant Clinically Non-Functioning Pituitary Adenoma Presenting as New Onset Generalized Tonic‒Clonic Seizures: A Case Report

“…While visual impairments and visual field defects (72%), followed by headache (13%), are the commonest preoperative presentations of these entities, seizures, particularly of the generalized tonic clonic type, are extremely rare and limited to a handful of case reports. 3,6,[8][9][10][11][12] (Table 2) Convulsions are hypothesized to occur when the tumour invades the suprasellar area and/or the nervous system, specifically the frontal and temporal lobes, generating an epileptogenic focus. 4 However, it is important to note that seizures are increasingly common in patients with prolactinomas, specifically those treated with dopamine agonists such as cabergoline and bromocriptine, as discussed in depth through multiple case studies and case series.…”

“…Presentations of seizures much less seizures as the only complaint in non-functioning PitNETs are observed in a very limited number of case reports. 3,6,12 Out of them all, a case report by Vakharia et al, 3 is closely related to the index case, which describes a 40year-old man presenting with new-onset generalized seizures to be investigated and diagnosed with a trilobed GCNFPA. Moreover, immunohistochemical findings of the previous case support the involvement of prolactin-producing tumour cells in the pathogenesis of this disease, providing direction for further research on this topic.…”

“…Managed with anticonvulsants. Died at 11 months of follow-up Hong et al 6 54/M GTC x 1 episode/episodic metallic taste x 10 months Normal Tumour extending to cavernous sinus and medial temporal lobe Non-functioning pituitary adenoma (ki 67: <2%) N/S Follow-up MRI (6 month) shows residual tumour/12 months seizure free on treatment Jamaluddin et al 12 51/M Headache/visual loss/ataxia/seizures Normal Knosp grade 3 pituitary lesion Gonadotroph secreting tumor (ki 67: 3–4%) N/S Follow-up for 29 months – Left cavernous sinus tumour residue Papanastasiou et al 9 42/M GTC x 1 episode/decreased consciousness/visual loss/headache, erectile dysfunction, loss of libido x 6 years PRL:2000 (3.46 −19.4 ng/mL) and multiple AP hormone deficiency 60x35 mm with mass effect Lactotroph Pituitary Adenoma (ki 67: 1%) PRL reduced to 90.7 ng/mL following DA (CAB) Initial CAB followed by surgery due to worsening visual impairment from chiasmal herniation. Seizure free (follow-up period N/S) Deepak et al 11 33/M GTC/oral automatism PRL: 28,000 ng/mL Suprasellar mass reaching third ventricle Lactotroph Pituitary Adenoma (ki 67: N/S) PRL reduced to 5239 ng/mL after 6 months of CAB CAB, AED and TSS.…”

Commentary: Endoscopic Endonasal Removal of a Laterally Extended Pituitary Adenoma Using Steerable Forceps: 2-Dimensional Operative Video

“…6,10,11 There have even been reported instances of growth reaching the third and lateral ventricles in more extreme cases. 12,13 Of note, most of these more invasive tumors consist of nonfunctioning adenomas or growth hormone-secreting adenomas. 11 As described by the authors in the operative video, their patient presented with a pituitary adenoma with a sizeable Knosp Grade 4 extension beyond the sella, predominantly involving the lateral cavernous sinus and retrocarotid space.…”