Radiologic Predictors for Extent of Resection in Pituitary Adenoma Surgery. A Single-Center Study

Sanmillán, José L.; Torres-Díaz, Alberto; Sanchez-Fernández, Juan José; Lau, Ruth; Ciller, Cristina; Puyalto, Paloma; Gabarrós, Andreu

doi:10.1016/j.wneu.2017.09.017

Cited by 32 publications

(25 citation statements)

References 22 publications

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“…PA invasion of the CS of was associated with incomplete resection and endocrine remission failure [7, 12]. Although radiologic CS invasion was not a guarantee of true CS invasion [8, 9], previous studies demonstrated that radiologic CS invasion using a modified Knosp grading system could predict the extent of resection in PA surgery [28, 29]. Woodworth et al [6] reported a GTR rate of 53.8% for modified Knosp-Steiner grade 1–2 PA and 8.7% in grade 3–4 using an endonasal endoscopic approach.…”

Section: Discussionmentioning

confidence: 99%

Gamma Knife Radiosurgery as a Primary Treatment for Nonfunctioning Pituitary Adenoma Invading the Cavernous Sinus

Lee

Cho

Choi

et al. 2020

Stereotact Funct Neurosurg

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Objectives: Surgical resection of nonfunctioning pituitary adenoma (NFPA) invading the cavernous sinus (CS) remains a challenging and significant factor associated with incomplete resection. The residual tumor in CS is usually treated with adjuvant stereotactic radiosurgery (SRS), but there is little information concerning SRS as an initial treatment for CS-invading NFPA. In this study, we investigated the tumor control rate and clinical outcomes of the patients who received primary gamma knife radiosurgery (GKRS) for CS-invading NFPA. Methods: This was a single-institute retrospective analysis of 11 patients. CS invasion of tumor was categorized using the modified Knosp grading system. The median tumor volume and maximal diameter were 1.6 cm 3 (range 0.4-6.5) and 17.2 mm (range 11.6-23.3), respectively. The median clinical follow-up period was 48.5 months (range 16.4-177.8). The median prescription dose at tumor margin was 15 Gy (range 11-25) and median prescription isodose was 50% (range 45-50). The maximum radiation dose to optic chiasm and optic nerve were 7.2 Gy (range 3.4-9.2) and 7.5 Gy (range 4.5-11.5), respectively. Results: Tumor control was achieved in all patients. The median tumor volume and maximal diameter at last follow-up were 0.4 cm 3 (range 0.1-2.3) and 11.4 mm (range 4.7-19.5), respectively. The median volume reduction rate was 52% (range 33-88). Six patients showed downgrading of modified Knosp grade after GKRS. No patients developed GKRS-related complications such as hypopituitarism or visual disturbance. Conclusions: SRS may be an alternative primary treatment option for CS-invading NFPA if there is no urgent and absolute indication for surgery such as optic apparatus compression.

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Section: Discussionmentioning

confidence: 99%

Gamma Knife Radiosurgery as a Primary Treatment for Nonfunctioning Pituitary Adenoma Invading the Cavernous Sinus

Lee

Cho

Choi

et al. 2020

Stereotact Funct Neurosurg

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“…Preoperative radiological diagnosis of CSI plays a crucial role in establishing prognosis and the therapeutic plan. Although we cannot exclude that even an adenoma with Knosp grade ≤ 2 may be invasive [115], pituitary tumors with Knosp grades 3B-4 are characterised by subtotal surgical resection, low biochemical remission rate [10,11,111,[116][117][118][119][120][121], need for complementary therapies, and a higher risk of recurrence [84]. However, radiology does not always allow discriminating between compression/extension and invasion of CS, and it might therefore overestimate CS invasion.…”

Section: Radiological Criteria and Classificationsmentioning

confidence: 99%

Pituitary Adenomas and Invasiveness from Anatomo-Surgical, Radiological, and Histological Perspectives: A Systematic Literature Review

Serioli

Doglietto

Fiorindi

et al. 2019

Cancers

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Invasiveness in pituitary adenomas has been defined and investigated from multiple perspectives, with varying results when its predictive value is considered. A systematic literature review, following PRISMA guidelines, was performed, searching PubMed and Scopus databases with terms that included molecular markers, histological, radiological, anatomical and surgical data on invasiveness of pituitary adenomas. The results showed that differing views are still present for anatomical aspects of the sellar region that are relevant to the concept of invasiveness; radiological and histological diagnoses are still limited, but might improve in the future, especially if they are related to surgical findings, which have become more accurate thanks to the introduction of the endoscope. The aim is to achieve a correct distinction between truly invasive pituitary adenomas from those that, in contrast, present with extension in the parasellar area through natural pathways. At present, diagnosis of invasiveness should be based on a comprehensive analysis of radiological, intra-operative and histological findings.

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“…Being clinically silent, NF-PitNETs are usually diagnosed at the stage of macroadenoma, although presentation as an incidentaloma is not uncommon [ 5 , 6 ]. Around 50% of the tumors infiltrate cavernous sinuses at the time of diagnosis, which limits radical surgery [ 8 , 9 ]. Even when radiologically radically removed, a significant proportion of the tumors demonstrate regrowth [ 8 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Histopathological classification of non-functioning pituitary neuroendocrine tumors

2017

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Non-functioning pituitary neuroendocrine tumors do not cause endocrine symptoms related to hypersecretion of adenohypophyseal hormones and are clinically characterized by symptoms due to growing sellar tumor mass. Histopathological classification of this tumor group has always been challenging due to their heterogeneity, limited knowledge on their biology, and diverse methodological problems. We have searched PubMed database for data related to the histopathological classification of non-functioning pituitary tumors and methods for its application. Principles of the classification and grading presented in the recently released 4th edition of the World Health Organization classification of endocrine tumors have been summarized. Based on the expression of anterior pituitary hormones and pituitary specific transcription factors, gonadotroph tumors dominate within the group of clinically non-functioning tumors, followed by corticotroph type; however, other less common types of the non-functioning tumors can be identified. Assessment of tumor cell proliferation is important to identify “high-risk adenomas.” A few subtypes of non-functioning tumors belong to the category of potentially aggressive tumors, independent of the cell proliferation rate. Here, we present up to date criteria for the classification of clinically non-functioning pituitary tumors, offer a diagnostic approach for the routine clinical use, and emphasize a need for inclusion of prognostic and predictive markers in the classification.

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Radiologic Predictors for Extent of Resection in Pituitary Adenoma Surgery. A Single-Center Study

Cited by 32 publications

References 22 publications

Gamma Knife Radiosurgery as a Primary Treatment for Nonfunctioning Pituitary Adenoma Invading the Cavernous Sinus

Gamma Knife Radiosurgery as a Primary Treatment for Nonfunctioning Pituitary Adenoma Invading the Cavernous Sinus

Pituitary Adenomas and Invasiveness from Anatomo-Surgical, Radiological, and Histological Perspectives: A Systematic Literature Review

Histopathological classification of non-functioning pituitary neuroendocrine tumors

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