Giant invasive pituitary adenomas: surgical approach selection paradigm and its influence on the outcome—case series

Author:

Saad MahmoudORCID,Taha Ahmed Nageeb,Serag Samer,Shata Hosam,Zakaria Wael K.

Abstract

Abstract Objective Pointing out our surgical strategy and experience in selection of surgical approaches in giant pituitary adenomas patients and its relation to surgical and clinical outcome. Methods 31 patients with giant pituitary adenomas (maximum diameter ≥ 4 cm). We analyzed the preoperative clinical presentation, radiological criteria of the tumor, endocrinological profile, approach selected, extent of resection, clinical outcomes and complications. Results 16 males (51.6%) and 15 females (48.4%). All the patients had a visual complaint (13 had mild impairment (41.9%), 18 had significant visual loss (58.1%). 20 were nonfunctioning (64.6%), 5 prolactin secreting (16%) and 6 growth hormone secreting (19.4%). Surgical approaches included: standard endoscopic endonasal approach in 7, extended approach in 4, transcranial (extended pterional approach) in 3. Staged endoscopic surgery in 5. Extended pterional approach followed endoscopic approach in 12. Gross total resection in 18 (58%) subtotal resection in 8 patients (25.8%) and partial resection in 5 patients (16.2%). The most common complications was tumor recurrence in 8, CSF leakage in 3, Permanent diabetes insipidus in 2, postoperative hydrocephalus in 1, transient 6th CN palsy in 3, and unfortunately only one patient died. 8 had complete Visual recovery, 9 were improved partially, and 11 remain unchanged. Only 3 showed further deterioration of vision. Conclusions Giant invasive pituitary adenoma is still one of the challenging issues in decision making for selection of the appropriate management strategy. Advancement of the endoscopic surgical techniques made the transsphenoidal approach is the primary choice for management of giant pituitary adenoma. However, the door is still opened for transcranial approach as staged the procedure after endoscopic approach or sole approach for some selected cases.

Publisher

Springer Science and Business Media LLC

Subject

General Materials Science

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3