Transcranial versus Endoscopic Transsphenoidal Approaches in Management of Recurrent Giant Pituitary Adenomas

Authors

  • Mohamed Ismail Faculty of Medicine, Cairo University, Giza, Cairo, Egypt
  • Omar Abdel Aleem Abdel Moneim Ragab Faculty of Medicine, Cairo University, Giza, Cairo, Egypt
  • Mohamed M. Salama Faculty of Medicine, Cairo University, Giza, Cairo, Egypt
  • Basim M. Ayoub Faculty of Medicine, Cairo University, Giza, Cairo, Egypt
  • Wael Elmahdy Faculty of Medicine, Cairo University, Giza, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2020.4213

Keywords:

Recurrent pituitary adenoma, Giant pituitary adenoma, Transcranial, Endoscopic transsphenoidal

Abstract

AIM: The aim of this study was to compare the transcranial and the endoscopic transsphenoidal approaches for patients with recurrent giant pituitary adenomas as regards the extent of tumor resection and the clinical outcome.

METHODS: The study included 21 patients with recurrent giant pituitary adenomas divided into two groups; Group A included nine patients operated on by transcranial approaches and Group B included 12 patients operated on by the endoscopic transsphenoidal approach. Both groups were compared as regards the extent of tumor resection and the post-operative clinical outcome, particularly the visual and endocrinological outcomes, in addition to morbidity and mortality.

RESULTS: There was a higher incidence of total and near-total resection in Group B (41.7%) and a higher incidence of subtotal resection in Group A (55.6%). The incidence of visual improvement was higher in Group B (55.6%) than in Group A (28.6%). Post-operative biochemical remission was achieved in 100% of Group B patients and in 50% of Group A patients with functioning adenomas. The incidence of post-operative complications was higher in Group A (77.8%) than in Group B (50%).

CONCLUSION: The endoscopic transsphenoidal approach for recurrent giant pituitary adenomas is associated with a higher extent of tumor resection, better rates of visual improvement and endocrinological remission, and lower incidence of complications. The transcranial approach should be reserved for some adenomas with marked lateral or anterior extensions, fibrous tumors, and after the failure of the endoscopic transsphenoidal approach.

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References

Garibi J, Pomposo I, Villar G, Gaztambide S. Giant pituitary adenomas: Clinical characteristics and surgical results. Br J Neurosurg 2002;16(2):133-9. https://doi. org/10.1080/02688690220131723 PMid:12046731

Mortini P, Barzaghi R, Losa M, Boari N, Giovanelli M. Surgical treatment of giant pituitary adenomas: Strategies and results in a series of 95 consecutive patients. Neurosurgery 2007;60(6):993- 1002. https://doi.org/10.1227/01.neu.0000255459.14764.ba PMid:17538372

Agrawal A, Cincu R, Goel A. Current concepts and controversies in the management of non-functioning giant pituitary macroadenomas. Clin Neurol Neurosurg 2007;109(8):645-50. https://doi.org/10.1016/j.clineuro.2007.06.007 PMid:17686573

Sinha S, Sharma BS. Giant pituitary adenomas-an enigma revisited. Microsurgical treatment strategies and outcome in a series of 250 patients. Br J Neurosurg 2010;24(1):31-9. https:// doi.org/10.3109/02688690903370305 PMid:20158350

Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of giant pituitary adenomas. Pituitary 2012;15(2):150-9. https://doi. org/10.1007/s11102-011-0359-3 PMid:22038033

Vance ML. Diagnosis, management, and prognosis of pituitary tumors. In: Thapar K, Kovacs K, Scheithauer BW, Lloyd RV, editors. Diagnosis and Management of Pituitary Tumors. Totowa: Humana Press; 2001. p. 165-72. https://doi. org/10.1385/1592592171

Jane JA Jr., Thapar K, Laws ER Jr. Pituitary tumors: Functioning and nonfunctioning. In: Winn HR, editor. Youmans Neurological Surgery. Philadelphia, PA: Elsevier Saunders; 2011. p.1476-510. https://doi.org/10.1016/b978-1-4160-5316-3.00137-4

Koutourousiou M, Gardner PA, Fernandez-Miranda JC, Paluzzi A, Wang EW, Snyderman CH. Endoscopic endonasal surgery for giant pituitary adenomas: Advantages and limitations. J Neurosurg 2013;118(3):621-31. https://doi. org/10.3171/2012.11.jns121190 PMid:23289816

Han S, Gao W, Jing Z, Wang Y, Wu A. How to deal with giant pituitary adenomas: Transsphenoidal or transcranial, simultaneous or two-staged? J Neurooncol 2017;132(2):313-21. https://doi.org/10.1007/s11060-017-2371-6 PMid:28074324

Roelfsema F, Biermasz NR, Pereira AM. Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: A structured review and meta-analysis. Pituitary 2012;15(1):71-83. https://doi.org/10.1007/s11102-011-0347-7 PMid:21918830

Pratheesh R, Rajaratnam S, Prabhu K, Mani SE, Chacko G, Chacko AG. The current role of transcranial surgery in the management of pituitary adenomas. Pituitary 2013;16(4):419-34. https://doi.org/10.1007/s11102-012-0439-z PMid:23076713

D’Ambrosio AL, Syed ON, Grobelny BT, Freda PU, Wardlaw S, Bruce JN. Simultaneous above and below approach to giant pituitary adenomas: Surgical strategies and long-term follow-up. Pituitary 2009;12(3):217-25. https://doi.org/10.1007/ s11102-009-0171-5 PMid:19242807

Youssef AS, Agazzi S, van Loveren HR. Transcranial surgery for pituitary adenomas. Oper Neurosurg. 2005;57(Suppl 1):168-75 https://doi.org/10.1227/01.neu.0000163602.05663.86

Buchfelder M, Kreutzer J. Transcranial surgery for pituitary adenomas. Pituitary. 2008;11(4):375-84. https://doi.org/10.1007/ s11102-008-0120-8

Tajudeen BA, Mundi J, Suh JD, Bergsneider M, Wang MB. Endoscopic endonasal surgery for recurrent pituitary tumors: Technical challenges to the surgical approach. J Neurol Surg B Skull Base 2015;76(1):50-6. https://doi. org/10.1055/s-0034-1383856 PMid:25685650

Do H, Kshettry VR, Siu A, Belinsky I, Farrell CJ, Nyquist G, et al. Extent of resection, visual, and endocrinologic outcomes for endoscopic endonasal surgery for recurrent pituitary adenomas. World Neurosurg 2017;102:35-41. https://doi.org/10.1016/j. wneu.2017.02.131 PMid:28286277

Nishioka H, Hara T, Nagata Y, Fukuhara N, Yamaguchi- Okada M, Yamada S. Inherent tumor characteristics that limit effective and safe resection of giant nonfunctioning pituitary adenomas. World Neurosurg 2017;106:645-52. https://doi. org/10.1016/j.wneu.2017.07.043 PMid:28735124

Cavallo LM, Solari D, Tasiou A, Esposito F, de Angelis M, D’Enza AI, et al. Endoscopic endonasal transsphenoidal removal of recurrent and regrowing pituitary adenomas: Experience on a 59-patient series. World Neurosurg 2013;80(3-4):342-50. https://doi.org/10.1016/j.wneu.2012.10.008 PMid:23046913

Rudnik A, Zawadzki T, Gałuszka-Ignasiak B, Bazowski P, Duda I, Wojtacha M, et al. Endoscopic transsphenoidal treatment in recurrent and residual pituitary adenomas first experience. Minim Invasive Neurosurg 2006;49(1):10-4. https:// doi.org/10.1055/s-2006-932126 PMid:16547875

Thapar K, Laws ER Jr. Pituitary surgery. In Thapar K, Kovacs K, Scheithauer BW, Lloyd RV, editors. Diagnosis and Management of Pituitary Tumors. Totowa: Humana Press; 2001. p. 225-46. https://doi.org/10.1385/1-59259-217-1:225

de Divitiis E, de Divitiis O. Surgery for large pituitary adenomas: What is the best way? World Neurosurg 2012;77(3-4):448-50. https://doi.org/10.1016/j.wneu.2011.09.044 PMid:22120242

Zada G, Du R, Laws ER Jr. Defining the “edge of the envelope”: patient selection in treating complex sellar-based neoplasms via transsphenoidal versus open craniotomy. J Neurosurg 2011;114:286-300. https://doi.org/10.3171/2010.8.jns10520 PMid:20815698

Nishioka H, Hara T, Usui M, Fukuhara N, Yamada S. Simultaneous combined supra-infrasellar approach for giant/ large multilobulated pituitary adenomas. World Neurosurg 2012;77(3-4):533-9. https://doi.org/10.1016/j.wneu.2011.07.013 PMid:22120331

Pierallini A, Caramia F, Falcone C, Tinelli E, Paonessa A, Ciddio AB, et al. Pituitary macroadenomas: preoperative evaluation of consistency with diffusion-weighted MR imaging- -initial experience. Radiology 2006;239(1):223-31. https://doi. org/10.1148/radiol.2383042204 PMid:16452397

Yamamoto J, Kakeda S, Shimajiri S, Takahashi M, Watanabe K, Kai Y, et al. Tumor consistency of pituitary macroadenomas: Predictive analysis on the basis of imaging features with contrast-enhanced 3D FIESTA at 3T. AJNR Am J Neuroradiol 2014;35(2):297-303. https://doi.org/10.3174/ajnr.a3667 PMid:23928139

Smith KA, Leever JD, Chamoun RB. Prediction of Consistency of Pituitary Adenomas by Magnetic Resonance Imaging. J Neurol Surg B Skull Base 2015;76(5):340-3. https:// doi.org/10.1055/s-0035-1549005 PMid:26401474

Recinos PF, Goodwin CR, Brem H, Quiñones-Hinojosa A. Transcranial surgery for pituitary macroadenomas. In: Quinones-Hinojosa A, editor. Schmidek and Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results. Philadelphia. PA: Elsevier Saunders; 2012. p. 280-91. https:// doi.org/10.1016/b978-1-4160-6839-6.10023-1

Chang EF, Sughrue ME, Zada G, Wilson CB, Blevins LS Jr., Kunwar S. Long term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas. Pituitary 2010;13(3):223-9. https://doi.org/10.1007/ s11102-010-0221-z PMid:20217484

Jagannathan J, Prevedello DM, Ayer VS, Dumont AS, Jane JA Jr., Laws ER. Computer-assisted frameless stereotaxy in transsphenoidal surgery at a single institution: Review of 176 cases. Neurosurg Focus 2006;20(2):E9. https://doi.org/10.3171/ foc.2006.20.2.10 PMid:16512660

Laws ER. The endoscopic endonasal approach for recurrent pituitary lesions. World Neurosurg 2013;80(3-4):272-3. https:// doi.org/10.1016/j.wneu.2012.11.041 PMid:23165173

Laws ER Jr., Fode NC, Redmond MJ. Transsphenoidal surgery following unsuccessful prior therapy. An assessment of benefits and risks in 158 patients. J Neurosurg 1985;63(6):823-9. https:// doi.org/10.3171/jns.1985.63.6.0823 PMid:2997414

Pollock BE, Kondziolka D, Lunsford LD, Flickinger JC. Stereotactic radiosurgery for pituitary adenomas: Imaging, visual and endocrine results. Acta Neurochir Suppl 1994;62:33-8. https://doi.org/10.1007/978-3-7091-9371-6_7 PMid:7717132

Wang S, Lin S, Wei L, Zhao L, Huang Y. Analysis of operative efficacy for giant pituitary adenoma. BMC Surg 2014;14:59. https://doi.org/10.1186/1471-2482-14-59 PMid:25163653

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Published

2020-04-08

How to Cite

1.
Ismail M, Abdel Aleem Abdel Moneim Ragab O, Salama MM, Ayoub BM, Elmahdy W. Transcranial versus Endoscopic Transsphenoidal Approaches in Management of Recurrent Giant Pituitary Adenomas. Open Access Maced J Med Sci [Internet]. 2020 Apr. 8 [cited 2024 Mar. 28];8(B):273-80. Available from: https://oamjms.eu/index.php/mjms/article/view/4213