Pituitary adenomas: historical perspective, surgical management and future directions

Abstract

Pituitary adenomas are among the most common central nervous system tumors. They represent a diverse group of neoplasms that may or may not secrete hormones based on their cell of origin. Epidemiologic studies have documented the incidence of pituitary adenomas within the general population to be as high as 16.7%. A growing body of work has helped to elucidate the pathogenesis of these tumors. Each subtype has been shown to demonstrate unique cellular changes potentially leading to tumorigenesis. Surgical advancements over several decades have included microsurgery and the employment of the endoscope for surgical resection. These advancements increase the likelihood of gross-total resection and have resulted in decreased patient morbidity.

In-Hospital Postoperative Complications in Patients With Pituitary Adenoma Who Underwent Pituitary Surgery From January 2010 to December 2015: A Multicenter Study

“…Similarly, in the literature, complications related to the trans-sphenoidal approach are mainly CSF leak followed by diabetes insipidus, postoperative nausea and vomiting, and hematoma at operation site [25,26]. On the other hand, potential risks for the transcranial approach are frontal lobe damage manifested postoperatively as changes in memory, judgment, concentration, personality and anosmia [2]. These clinical manifestations were not reported in this study.…”

“…On the other hand, patients with non-functional PAs undergo surgery when clinically manifest mass effects are noted like visual disturbances, headaches, or hypopituitarism. The decision to undergo transcranial surgery is dictated mainly by the extension or invasiveness of the tumor like adenomas with prominent extrasellar extension and adenomas with extensive fibrosis; failed trans-sphenoidal surgery and inadequate decompression; and uncertain diagnosis [2].…”

“…2017;7(4):122-130 hypothalamus and optic apparatus. For transcranial approach, complications generally relate to frontal lobe and optic nerve damage, and uncommonly, hypothalamic damage [2]. In the Philippines, Fonte et al identified the complications in the immediate postoperative period in patients who underwent pituitary surgery, namely, transient diabetes insipidus, cerebrospinal fluid (CSF) leak, hemorrhage, transient worsening of vision and death [7].…”

Pituitary adenoma: a literature review

“…Ki tø HA gy dy mas vais tais yra ma þiau efek ty vus [10,12]. AKTH sek re tuo jan èioms ir Ku ðin go li gà su ke lianèioms ade no moms pir mo pa si rin ki mo gy dy mo me to das yra trans fe noi da li në chi rur gi ja.…”

“…Antro ji kla si fi ka ci ja, pa gal Knosp, re mia si HA in va zi ja á aky tà já an tá. Pa gal tai ski ria mos ðios sta di jos: 0 -nor ma (në ra au gimo aky to jo an èio link), 1 -na vi kas ne per au ga hi po te ti nës li ni jos tarp dvie jø vi di nës mie go ar te ri jos seg men tø cen trø, 2 -na vi kas per au ga hi po te ti nae li ni jà tarp dvie jø vi di nës mie go ar te ri jos cen trø, ta èiau ne per au ga hi po te ti nës li ni jos, ið ves tos per la te ra li nae mie go ar te ri jos sie ne lae, 3 -na vi kas au ga la te ra liau vi di nës mie go ar te ri jos, 4 -na vi kas vi sið kai ap su pa vi di nës mie go ar te ri jos aky to jo an èio seg men tà [12].…”