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How to deal with giant pituitary adenomas: transsphenoidal or transcranial, simultaneous or two-staged?

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Abstract

Giant pituitary adenomas (diameter >4 cm) are a challenge to treat, and there is no consensus on the optimal surgical strategy. We report here our experience in surgical management of these lesions. Adult patients with giant pituitary adenomas (n = 62; 54 non-functioning and eight hormone-secreting adenomas) who underwent surgical resection at our hospital from 2009 to 2015 were retrospectively reviewed. Surgical and clinical outcomes were analyzed. Single transsphenoidal and transcranial approaches were used in 43 (69.4%) and four (6.5%) patients, respectively. A combined transsphenoidal and transcranial approach was used in 13 patients (20.9%) and in two patients (3.2%), a transcranial procedure was followed 3 months later by a transsphenoidal approach. Greater than 90% resection was achieved in 47 cases (75.8%). During a mean follow-up period of 46.9 months, 49 patients (79%) showed improved visual impairment scores, while none experienced visual deterioration. There was no post-operative hemorrhage or mortality. A total of 27 patients (43.5%) received adjuvant medical and/or radiation therapy. At last follow-up, eight patients (12.9%) had recurrence. For giant pituitary adenoma, the transsphenoidal and transcranial approaches should be combined flexibly based on the characteristics of the tumor. In certain cases, a simultaneous combined approach can maximize tumor extirpation and lower the risk of swelling and bleeding of the residual tumor.

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Abbreviations

BMI:

Body mass index

GH:

Growth hormone

GPA:

Giant pituitary adenoma

KPS:

Karnofsky performance score

MRI:

Magnetic resonance imaging

NFPA:

Nonfunctioning pituitary adenoma

PA:

Pituitary adenoma

PRL:

Prolactin

VIS:

Visual impairment score

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Authors and Affiliations

  1. Department of Neurosurgery, The First Hospital of China Medical University, Nanjing Street 155, Heping District, Shenyang, 110001, China

    Sheng Han, Wei Gao, Zhitao Jing, Yunjie Wang & Anhua Wu

Authors
  1. Sheng Han
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  2. Wei Gao
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  3. Zhitao Jing
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  4. Yunjie Wang
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  5. Anhua Wu
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Correspondence to Anhua Wu.

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The authors have no conflict of interest to declare.

Electronic supplementary material

Below is the link to the electronic supplementary material.

11060_2017_2371_MOESM1_ESM.tif

Supplementary Figure 1. A 51-year-old female patient presented with visual loss and headache, and subsequently underwent single endoscopic transsphenoidal surgery. A, B: A preoperative MRI revealed a non-functioning GPA with suprasellar extension, as seen in the sagittal (A) and coronal (B) planes. C, D: A postoperative MRI showed near-total removal of the tumor, as seen in the sagittal (C) and coronal (D) planes. (TIF 1732 KB)

Supplementary material 2 (DOC 39 KB)

11060_2017_2371_MOESM3_ESM.tif

Supplementary Figure 2. A 66-year-old male patient presented with progressive visual loss and headache, and subsequently underwent transcranial surgery. The frontobasal interhemispheric approach was used. A, B: A preoperative MRI revealed a GPA with significant suprasellar intraventricular extension, although the intrasellar tumor was very small, as seen in the sagittal (A) and axial (B) planes. C, D: A postoperative MRI showed complete removal of the suprasellar tumor, as seen in the sagittal (C) and axial (D) planes. The intrasellar residual tumor was removed using a second-stage transsphenoidal approach (TIF 5155 KB)

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Han, S., Gao, W., Jing, Z. et al. How to deal with giant pituitary adenomas: transsphenoidal or transcranial, simultaneous or two-staged?. J Neurooncol 132, 313–321 (2017). https://doi.org/10.1007/s11060-017-2371-6

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  • DOI: https://doi.org/10.1007/s11060-017-2371-6

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