Endoscopic Endonasal Transsphenoidal Removal of Recurrent and Regrowing Pituitary Adenomas: Experience on a 59-Patient Series

Cavallo, Luigi Maria; Solari, Domenico; Τάσιου, Αναστασία; Esposito, Felice; Angelis, Marcello De; D’Enza, Alfonso Iodice; Cappabianca, Paolo

doi:10.1016/j.wneu.2012.10.008

Cited by 61 publications

(59 citation statements)

References 74 publications

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“…They concluded that most pituitary adenoma without cavernous sinus invasion could be totally removed in the revision surgery with a wider exposure. Cavallo et al5) suggested the wide anterior sphenoidotomy in endoscopic TSA allowed a better dissection of scar tissue in sphenoid sinus and wider opening of sellar floor even in revision surgery following microscopic TSA. Compared to a microscope, the wide and multi-angled view of endoscope offers a better anatomic orientation along the entire surgical route to sella even in revision surgery, although the anatomical features of nasal cavity could be helpful21).…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of Endoscopic Endonasal Approach for Recurrent Pituitary Adenomas after Microscopic Trans-Sphenoidal Approach

Hwang

Kim

et al. 2013

J Korean Neurosurg Soc

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ObjectiveThe surgical approach for recurrent pituitary adenoma after trans-sphenoidal approach (TSA) is challenging. We report the outcomes of the endoscopic TSA for recurrent pituitary adenoma after microscopic TSA.MethodsFrom February 2010 to February 2013, endoscopic TSA was performed for removal of 30 recurrent pituitary adenomas after microscopic TSA. Twenty-seven (90%) patients had a clinically non-functioning pituitary adenoma. Twenty-four (80%) patients suffered from a visual disturbance related to tumor growth. The clinical features and surgical outcomes were retrospectively analyzed for the ophthalmological, endocrinological, and oncological aspects.ResultsThe mean tumor volume was 11.7 cm3, and gross total resection was achieved in 50% of patients. The volumetric analysis based on the postoperative MR showed that the mean extent of resection rates were 90%. Vision was improved in 19 (79%) of 24 patients with visual symptoms, and endocrinological cure was achieved in all of three functioning pituitary adenomas; however, the post-operative follow-up endocrinological examination revealed a new endocrinological deficit in one patient. Two patients required antibiotics management for post-operative meningitis.ConclusionThe endoscopic TSA can be an effective treatment option for recurrent pituitary adenoma after microscopic TSA with acceptable outcome.

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Section: Discussionmentioning

confidence: 99%

“…In the literatures, the efficacy and safety of endoscopic TSA in the management of pituitary adenomas have been proven and the complication rates of endoscopic TSA are at least comparable with those of microscopic series17,18,28). However, the reports on endoscopic TSA as a revision surgery have been rarely published5,32).…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Endoscopic Endonasal Approach for Recurrent Pituitary Adenomas after Microscopic Trans-Sphenoidal Approach

Hwang

Kim

et al. 2013

J Korean Neurosurg Soc

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“…6,14,22,43,47) Injury of the carotid artery is a rare but severe and potentially fatal complication and is reported with a rate of less than 1%. 6,15,42,44–46) In general, the surgical complication rates of endoscopic procedure are either equivocal or slightly superior to those of microscopic procedure. 6,12,15,22,43–46) However, Ammitirati M et al 43) noted a higher incidence of vascular complications with endoscopic technique.…”

Section: Complicationsmentioning

confidence: 99%

“…However, the endoscopic endonasal surgery has been reported to be a valid option in recurrent adenomas. 34,40–42) In addition to the various advantages of the endoscope that has been mentioned, a wider exposure of the sella by the endoscopic approach may contribute to the better outcome, especially when the limited exposure by the previous microscopic surgery had been a major factor of incomplete tumor resection. 40–42) …”

Section: Introductionmentioning

confidence: 99%

Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

Nishioka

2017

Neurol. Med. Chir.(Tokyo)

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For the treatment of pituitary tumors, microscopic transsphenoidal surgery has been considered the “gold standard” since the late 1960s. Over the last two decades, however, a worldwide shift towards endoscopic endonasal surgery is in progress for many reasons. These include a wide panoramic view, improved illumination, an ability to look around anatomical corners using angled tip and, in addition, application to the extended approaches for parasellar tumors. Both endoscopic and microscopic approaches appear equally effective for nonfunctioning adenomas without significant suprasellar or lateral extensions, whereas the endoscopic approach may improve outcomes associated with the extent of resection and postoperative complications for larger tumors. Despite many theoretical benefits in the endoscopic surgery, remission rates of functioning adenomas do not substantially differ between the approaches in experienced hands. The endoscopic approach is a valid alternative to the microscopic approach for adenomas. The benefits will be more appreciated in the extended surgery for parasellar tumors.

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“…A transsphenoidal approach using either endoscopic or microsurgical techniques results in a gross total resection in more than 50% of patients with large pituitary adenomas, with a relatively low rate of postoperative complications and no mortality (7,8,9). A transcranial approach may represent an effective treatment for large tumors with extensive suprasellar extension that is associated with a subtotal removal in up to 75% of tumors and an improvement of vision in more than half patients (10,11,12); however, major morbidity (e.g., cranial nerves deficits, hypothalamic and vascular injuries, and CSF leakages) and mortality have been reported in 18-25 and 2.7-4.4% of patients respectively.…”

Section: Discussionmentioning

confidence: 99%

Fractionated stereotactic radiotherapy for large and invasive non-functioning pituitary adenomas: long-term clinical outcomes and volumetric MRI assessment of tumor response

Minniti

Scaringi

Poggi

et al. 2015

European Journal of Endocrinology

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Objective: We describe the use of fractionated stereotactic radiotherapy (FSRT) for the treatment of large, invasive, nonfunctioning pituitary adenomas (NFPAs). FSRT is frequently employed for the treatment of residual or recurrent pituitary adenomas. Patients and methods: Sixty-eight patients with a large residual or recurrent NFPAs were treated between April 2004 and December 2012, including 39 males and 29 females (median age 51 years). Visual defects were present in 34 patients, consisting of visual field defects (nZ31) and/or reduced visual acuity (nZ12). Forty-five patients had evidence of partial or total hypopituitarism before FSRT. For most of the patients, the treatment was delivered through 5-10 noncoplanar conformal fixed fields using a 6-MV linear accelerator to a dose of 45 Gy in 25 fractions. Results: At a median follow-up of 75 months (range 12-120 months), the 5-and 10-year actuarial local control were 97 and 91%, respectively, and overall survival 97 and 93%, respectively. Forty-nine patients had a tumor reduction, 16 remained stable, and three progressed. The relative tumor volume reduction measured using three-dimensional (3D) magnetic resonance imaging (MRI) was 47%. The treatment was well tolerated with minimal acute toxicity. Eighteen patients developed partial or complete hypopituitarism. The actuarial incidence of new anterior pituitary deficits was 40% at 5 years and 72% at 10 years. No other radiation-induced complications occurred. Conclusions: Our results suggest that FSRT is an effective treatment for large or giant pituitary adenomas with low toxicity.

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Endoscopic Endonasal Transsphenoidal Removal of Recurrent and Regrowing Pituitary Adenomas: Experience on a 59-Patient Series

Cited by 61 publications

References 74 publications

Feasibility of Endoscopic Endonasal Approach for Recurrent Pituitary Adenomas after Microscopic Trans-Sphenoidal Approach

Feasibility of Endoscopic Endonasal Approach for Recurrent Pituitary Adenomas after Microscopic Trans-Sphenoidal Approach

Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

Fractionated stereotactic radiotherapy for large and invasive non-functioning pituitary adenomas: long-term clinical outcomes and volumetric MRI assessment of tumor response

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