2021
DOI: 10.3390/cancers13143603
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Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience

Abstract: Purpose: To evaluate factors influencing clinical and radiological outcome of extended endoscopic endonasal transtuberculum/transplanum approach (EEA-TTP) for giant pituitary adenomas (GPAs). Methods: We recruited prospectively all consecutive GPAs patients undergoing EEA-TTP between 2015 and 2019 in 5 neurosurgical centers. Preoperative clinical and radiologic features, visual and hormonal outcomes, extent of resection (EoR), complications and recurrence rates were recorded and analyzed. Results: Of 1169 pati… Show more

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Cited by 27 publications
(19 citation statements)
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“…The surgical paradigm for radical resection with high functional morbidity has shifted toward promoting tailored resection under neuromonitoring to allow for optimal functional outcomes and then supplemental treatment of suspicious residual lesions by stereotactic radiosurgery and radiotherapy. Although standard fashions such as endonasal approach or open surgery without cerebral revascularization to treat such formidable can achieve satisfactory results ( 13 16 ), the majority of patients in our series are treated with unsatisfactory attempt at tailored resection by irradiation with incomplete and ineffective modalities. In our series, the r-knife failed to control the initial residual tumor in 3 patients with recurrence; these patients were followed by subtotal resection of 2 meningiomas and 1 hemangiopericytoma, indicating poor tolerance to new radiation treatment.…”
Section: Discussionmentioning
confidence: 87%
“…The surgical paradigm for radical resection with high functional morbidity has shifted toward promoting tailored resection under neuromonitoring to allow for optimal functional outcomes and then supplemental treatment of suspicious residual lesions by stereotactic radiosurgery and radiotherapy. Although standard fashions such as endonasal approach or open surgery without cerebral revascularization to treat such formidable can achieve satisfactory results ( 13 16 ), the majority of patients in our series are treated with unsatisfactory attempt at tailored resection by irradiation with incomplete and ineffective modalities. In our series, the r-knife failed to control the initial residual tumor in 3 patients with recurrence; these patients were followed by subtotal resection of 2 meningiomas and 1 hemangiopericytoma, indicating poor tolerance to new radiation treatment.…”
Section: Discussionmentioning
confidence: 87%
“…CSF leak is one of the most common postoperative complications after EES for pituitary adenomas. According to literature reports, the incidence of CSF leak after EES for pituitary adenomas ranges from 2.6% to 12.1% ( 4 , 11 17 ). In the current study, 3.5% of patients with pituitary adenomas developed cerebrospinal fluid leakage after EES.…”
Section: Discussionmentioning
confidence: 99%
“…We intend to remove the cotton patties in the near future after confirming that the blood flow of the ICA petrous portion is obstructed. Chibbaro et al had no instances of ICA injury even in difficult cases such as giant pituitary adenoma ( 16 18 ). A careful preoperative assessment of tumor characteristics, a multidisciplinary team of Neurosurgery/Otorhinolaryngology specialists, and the assistance of intraoperative navigation and micro-Doppler ultrasonography are beneficial in reducing the risk of unexpected complications in ETSS for pituitary and parasellar tumors, as Chibbaro et al advocated ( 16 20 ).…”
Section: Discussionmentioning
confidence: 99%