Primary Endoscopic Transnasal Transsphenoidal Surgery for Giant Pituitary Adenoma

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• 作者：Chao-Hung Kuo¹ ; ² ; Yu-Shu Yen¹ ; ² ; Jau-Ching Wu¹ ; ² ; ^{jauching@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Peng-Yuan Chang¹ ; ² ; Hsuan-Kan Chang¹ ; ² ; Tsung-Hsi Tu¹ ; ² ; ⁴ ; Wen-Cheng Huang¹ ; ² ; Henrich Cheng¹ ; ² ; ³
• 关键词：CSF leakage ; Endoscopic transsphenoidal surgery ; Giant pituitary adenoma
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：91
• 期：Complete
• 页码：121-128
• 全文大小：2727 K

文摘

Giant pituitary adenoma (>4 cm) remains challenging because the optimal surgical approach is uncertain.

Methods

Consecutive patients with giant pituitary adenoma who underwent endoscopic transnasal transsphenoidal surgery (ETTS) as the first and primary treatment were retrospectively reviewed. Inclusion criteria were tumor diameter ≥4 cm in at least 1 direction, and tumor volume ≥10 cm³. Exclusion criteria were follow-ups <2 years and diseases other than pituitary adenoma. All the clinical and radiologic outcomes were evaluated.

Results

A total of 38 patients, average age 50.8 years, were analyzed with a mean follow-up of 72.9 months. All patients underwent ETTS as the first and primary treatment, and 8 (21.1%) had complete resection without any evidence of recurrence at the latest follow-up. Overall, mean tumor volume decreased from 29.7 to 3.2 cm³ after surgery. Residual and recurrent tumors (n = 30) were managed with 1 of the following: Gamma Knife radiosurgery (GKRS), reoperation (redo ETTS), both GKRS and ETTS, medication, conventional radiotherapy, or none. At last follow-up, most of the patients had favorable outcomes, including 8 (21.1%) who were cured and 29 (76.3%) who had a stable residual condition without progression. Only 1 (2.6%) had late recurrence at 66 months after GKRS. The overall progression-free rate was 97.4%, with few complications.

Conclusions

In this series of giant pituitary adenoma, primary (ie, the first) ETTS yielded complete resection and cure in 21.1%. Along with adjuvant therapies, including GKRS, most patients (97.4%) were stable and free of disease progression. Therefore, primary ETTS appeared to be an effective surgical approach for giant pituitary adenoma.