Outcome of giant pituitary tumors requiring surgery

Abstract

ObjectiveThe management of giant pituitary tumors is complex, with few publications and recommendations. Consequently, patient’s care mainly relies on clinical experience. We report here a first large series of patients with giant pituitary tumors managed by a multidisciplinary expert team, focusing on treatments and outcome.MethodsA retrospective cohort study was conducted. Giant pituitary tumors were defined by a main diameter > 40mm. Macroprolactinomas sensitive to dopamine agonists were excluded. All patients were operated by a single neurosurgical team. After surgery, multimodal management was proposed, including hormone replacement, radiotherapy and anti-tumor medical therapies. Outcome was modeled using Kaplan-Meyer representation. A logistic regression model was built to identify the risk factors associated with surgical complications.Results63 consecutive patients presented a giant adenoma, most often with visual defects. Patients were operated once, twice or three times in 59%, 40% and 1% of cases respectively, mainly through endoscopic endonasal approach. Giant adenomas included gonadotroph, corticotroph, somatotroph, lactotroph and mixed GH-PRL subtypes in 67%, 14%, 11%, 6% and 2% of patients respectively. Vision improved in 89% of patients with prior visual defects. Severe surgical complications occurred in 11% of patients, mainly for tumors > 50 mm requiring microscopic transcranial approach. Additional radiotherapy was needed for 29% of patients, 3 to 56 months after first surgery. For 6% of patients, Temozolomide treatment was required, 19 to 66 months after first surgery.ConclusionsGiant pituitary tumors require multimodal management, with a central role of surgery. Most often, tumor control can be achieved by expert multidisciplinary teams.

Comparison of Clinical Outcomes between Microscopic and Endoscopic Transsphenoidal Pituitary Tumor Resection

“…This finding could be due to the soft consistency of an adenoma, making gross total resection achievable. 27 28 A more friable tumor that can easily be aspirated can present an easier experience with achieving gross total resection. 28 Consequently, a firmer tumor with a fibrous texture can be more challenging to fully remove, and therefore, warrant a longer surgery.…”

“…27 28 A more friable tumor that can easily be aspirated can present an easier experience with achieving gross total resection. 28 Consequently, a firmer tumor with a fibrous texture can be more challenging to fully remove, and therefore, warrant a longer surgery. 28 Other barriers to a gross total resection of pituitary tumors can be the anatomical location of the tumor, specifically if it has a greater suprasellar extension or cavernous sinus invasion.…”

“…28 Consequently, a firmer tumor with a fibrous texture can be more challenging to fully remove, and therefore, warrant a longer surgery. 28 Other barriers to a gross total resection of pituitary tumors can be the anatomical location of the tumor, specifically if it has a greater suprasellar extension or cavernous sinus invasion. 25,26 A study by Pei et al studied factors limiting gross total resection in pituitary adenomas and found that with microscopic resection, cavernous sinus invasion and greater suprasellar expansion can serve as obstacles towards achieving gross total resection.…”

Clinical presentation and surgical outcomes of very large and giant pituitary adenomas: 80 cases in a cohort study of 306 patients

“…Nevertheless, this is controversial as other studies have shown no correlation (48), probably because of the difference in the tumor subtypes. Hypopituitarism is a frequent complication in large/giant pituitary adenoma surgery (8, 49,50). It could be challenging to reproduce and identify the worsening or recovery of each anterior pituitary hormonal axis.…”

Changes in visual abnormalities after endonasal endoscopic surgery for giant pituitary adenoma with extension to the ventricular system

“…З огляду на велетенський розмір та інвазію в шлуночкову систему, радикальне видалення ВАГ пов'язано з високим ризиком пошкодження навколишніх структур, що може призвести до глибокої інвалідізації хворих [3,10,22,23,24,25].…”