Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Population
2.2. Data Collection
2.3. Endocrinological Evaluation
2.4. Ophtalmological Evaluation
2.5. Ethics
2.6. Statistical analysis
2.7. Surgical Technique
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Demographics | N. | % |
---|---|---|
Male | 55 | 57.3 |
Female | 41 | 42.7 |
Mean Age (years) | 52.2 (26–81) | |
Mean tumor diameter (mm) | 46.5 (41–61) | |
KNOSP Classification | ||
Grade 0 | 30 | 31.2 |
Grade 1 | 24 | 25.0 |
Grade 2 | 19 | 19.8 |
Grade 3 | 9 | 9.4 |
Grade 4 | 14 | 14.6 |
Endocrinological status | ||
Non-functioning | 96 | 100 |
Preoperative Clinical symptoms and signs | ||
Visual field defects | 78 | 81.2 |
Anterior pituitary insufficiency | 53 | 55.2 |
Headache | 12 | 12.5 |
Visual acuity deficit | 9 | 9.4 |
Drowsiness | 3 | 3.1 |
Treatment | ||
EEA-TTP 1 | 96 | 100 |
GPA consistency | ||
Soft | 50 | 52.1 |
Firm/fibrous | 46 | 47.9 |
GPA vascularization | ||
Significant | 31 | 32.3 |
Not significant | 65 | 67.7 |
Extent of resection | ||
GTR 2 (100%) | 34 | 35.4 |
NTR 3 (96 to 99%) | 12 | 12.5 |
STR 4 (75 to 95%) | 50 | 52.1 |
Clinical outcome | ||
Visual improvement | 77 | 98.7 |
Recovery of pituitary function | 27 | 50.9 |
Surgical complications | ||
CSF 5 leak | 7 | 7.3 |
Meningitis | 7 | 7.3 |
Apoplexy of residual tumor | 2 | 2.1 |
Hydrocephalus | 1 | 1.0 |
Right eye Blindness | 1 | 1.0 |
Transient DI | 37 | 37.5 |
Transient delayed hyponatremia | 20 | 20.8 |
Progression | ||
Yes | 16 | 16.7 |
No | 80 | 83.3 |
Treatment of 16 recurrences | ||
Re-do EEA-TTP | 3 | 3.1 |
GKRS 6 | 4 | 4.2 |
SRT 7 | 9 | 9.4 |
Surgical Approaches | EEA 1 | Microscopic Transsphenoidal | Transcranial | |
---|---|---|---|---|
Indications [20,21,22,23,24] | Medial wall cavernous invasion | Retro-chiasmatic extension of the tumor and expansion into the ventricular system | Temporal lobe invasion | |
Tumor extending into planum sphenoidale amenable for transplanum EEA approach | Very large or dumbbellshaped tumors (usually more than 50 mm) extending into the planum sphenoidale, middle fossa or retro-chiasmatic region, especially in case of a shallow sella and/or narrow inter-carotid space | |||
Contraindications [9,10,21,22] | Absolute | Tumor extension laterally to the supra-clinoidal part of the ICA 2 | N/A 3 | Cavernous invasion |
Relative | N/A 3 | Cavernous invasion | N/A 3 | |
Complications [19,31,41,42,46] | Visual deterioration | + | ++ | +++ |
Postoperative cranial nerve dysfunction | + | ++ | +++ | |
Pituitary function amelioration | ++ | + | + | |
Diabetes Insipidus | + | ++ | +++ | |
CSF leak | +++ | ++ | + | |
Meningitis | + | ++ | ++ | |
Mortality | + | + | + |
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Chibbaro, S.; Signorelli, F.; Milani, D.; Cebula, H.; Scibilia, A.; Bozzi, M.T.; Messina, R.; Zaed, I.; Todeschi, J.; Ollivier, I.; et al. Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience. Cancers 2021, 13, 3603. https://doi.org/10.3390/cancers13143603
Chibbaro S, Signorelli F, Milani D, Cebula H, Scibilia A, Bozzi MT, Messina R, Zaed I, Todeschi J, Ollivier I, et al. Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience. Cancers. 2021; 13(14):3603. https://doi.org/10.3390/cancers13143603
Chicago/Turabian StyleChibbaro, Salvatore, Francesco Signorelli, Davide Milani, Helene Cebula, Antonino Scibilia, Maria Teresa Bozzi, Raffaella Messina, Ismail Zaed, Julien Todeschi, Irene Ollivier, and et al. 2021. "Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience" Cancers 13, no. 14: 3603. https://doi.org/10.3390/cancers13143603