Inherent Tumor Characteristics That Limit Effective and Safe Resection of Giant Nonfunctioning Pituitary Adenomas

Nishioka, Hiroshi; Hara, Takayuki; Nagata, Yuichi; Fukuhara, Noriaki; Yamaguchi-Okada, Mitsuo; Yamada, Shozo

doi:10.1016/j.wneu.2017.07.043

Cited by 39 publications

(31 citation statements)

References 26 publications

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“…On the other hand, several authors did not consider this as an indication for transcranial surgery and have reported favorable outcomes with the endoscopic transsphenoidal approach (including expanded approaches) which provides a direct access along the tumor axis [8], [16], [18]. Cavernous sinus invasion was found in 28.6% of our cases, and its presence did not influence the choice of the approach in our study as well as in many other series as it presents a common limitation for radical tumor resection irrespective of the approach [8], [17], [19]. Four cases (19%) had marked extensions into the middle and anterior cranial fossa and all were operated on by transcranial approaches.…”

Section: Resultssupporting

confidence: 55%

“…The limitations to radical resection in our series included cavernous sinus extensions, significant anterior or middle fossa extensions, marked suprasellar extension into the third ventricle, and firm consistency. Similar limitations for radical resection were reported in several clinical series [8], [9], [17]. In cases with parasellar extension, our goal was to decompress the optic apparatus and reduce the tumor burden.…”

Section: Discussionsupporting

confidence: 56%

“…whether fresh or recurrent [8], [9], [17]. However, there were no articles focusing on the management of recurrent giant adenomas in particular.…”

Section: Resultsmentioning

confidence: 99%

“…More radical extent of resection leads to longer recurrence-free (progression-free) interval and better outcome. Several authors categorized the extent of resection of pituitary adenomas in various ways using different cutoffs for each category, thus making a uniform definition for the extent of resection non-applicable, and making comparisons with other authors about the achieved extent of resection difficult [8], [9], [12], [15, [16], [17], [18]. We achieved total or near-total resection in 28.6%, subtotal resection in 38.1%, and partial resection in 33.3% of all patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, these reports were not focusing on recurrent giant adenomas in particular. Some of these articles were addressing recurrent adenomas irrespective of the size [15], [16], while others were addressing the different surgical approaches for giant adenomas whether fresh or recurrent [8], [9], [17].…”

Section: Giantmentioning

confidence: 99%

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Transcranial versus Endoscopic Transsphenoidal Approaches in Management of Recurrent Giant Pituitary Adenomas

Ismail

Ragab

Salama

et al. 2020

Open Access Maced J Med Sci

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AIM: The aim of this study was to compare the transcranial and the endoscopic transsphenoidal approaches for patients with recurrent giant pituitary adenomas as regards the extent of tumor resection and the clinical outcome. METHODS: The study included 21 patients with recurrent giant pituitary adenomas divided into two groups; Group A included nine patients operated on by transcranial approaches and Group B included 12 patients operated on by the endoscopic transsphenoidal approach. Both groups were compared as regards the extent of tumor resection and the post-operative clinical outcome, particularly the visual and endocrinological outcomes, in addition to morbidity and mortality. RESULTS: There was a higher incidence of total and near-total resection in Group B (41.7%) and a higher incidence of subtotal resection in Group A (55.6%). The incidence of visual improvement was higher in Group B (55.6%) than in Group A (28.6%). Post-operative biochemical remission was achieved in 100% of Group B patients and in 50% of Group A patients with functioning adenomas. The incidence of post-operative complications was higher in Group A (77.8%) than in Group B (50%). CONCLUSION: The endoscopic transsphenoidal approach for recurrent giant pituitary adenomas is associated with a higher extent of tumor resection, better rates of visual improvement and endocrinological remission, and lower incidence of complications. The transcranial approach should be reserved for some adenomas with marked lateral or anterior extensions, fibrous tumors, and after the failure of the endoscopic transsphenoidal approach.

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Section: Resultssupporting

confidence: 55%

Section: Discussionsupporting

confidence: 56%

“…whether fresh or recurrent [8], [9], [17]. However, there were no articles focusing on the management of recurrent giant adenomas in particular.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Giantmentioning

confidence: 99%

See 3 more Smart Citations

Transcranial versus Endoscopic Transsphenoidal Approaches in Management of Recurrent Giant Pituitary Adenomas

Ismail

Ragab

Salama

et al. 2020

Open Access Maced J Med Sci

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show abstract

Predicting extent of resection in transsphenoidal surgery for pituitary adenoma

et al. 2018

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Solid tumor size for prediction of recurrence in large and giant non-functioning pituitary adenomas

Chang

Chen

et al. 2021

Neurosurg Rev

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A subset of large non-functioning pituitary adenomas (lNFPA) and giant non-functioning pituitary adenomas (gNFPA) undergoes early progression/recurrence (P/R) after surgery. This study revealed the clinical and image predictors of P/R in lNFPA and gNFPA, with emphasis on solid tumor size. This retrospective study investigated the preoperative MR imaging features for the prediction of P/R in lNFPA (> 3 cm) and gNFPA (> 4 cm). Only the patients with a complete preoperative brain MRI and undergone postoperative MRI follow-ups for more than 1 year were included. From November 2010 to December 2020, a total of 34 patients diagnosed with lNFPA and gNFPA were included (median follow-up time 47.6 months) in this study. A total of twenty-three (23/34, 67.6%) patients had P/R, and the median time to P/R is 25.2 months. Solid tumor diameter (STD), solid tumor volume (STV), and extent of resection are associated with P/R (p < 0.05). Multivariate analysis showed large STV is a risk factor for P/R (p < 0.05) with a hazard ratio of 30.79. The cutoff points of STD and STV for prediction of P/R are 26 mm and 7.6 cm3, with AUCs of 0.78 and 0.79 respectively. Kaplan–Meier analysis of tumor P/R trends showed that patients with larger STD and STV exhibited shorter progression-free survival (p < 0.05). For lNFPA and gNFPA, preoperative STD and STV are significant predictors of P/R. The results offer objective and valuable information for treatment planning in this subgroup.

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Inherent Tumor Characteristics That Limit Effective and Safe Resection of Giant Nonfunctioning Pituitary Adenomas

Cited by 39 publications

References 26 publications

Transcranial versus Endoscopic Transsphenoidal Approaches in Management of Recurrent Giant Pituitary Adenomas

Transcranial versus Endoscopic Transsphenoidal Approaches in Management of Recurrent Giant Pituitary Adenomas

Predicting extent of resection in transsphenoidal surgery for pituitary adenoma

Solid tumor size for prediction of recurrence in large and giant non-functioning pituitary adenomas

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