The value of computerized tomography in delineating suprasellar extension of pituitary adenomas for radiotherapeutic management

Abstract BACKGROUND Giant pituitary adenomas (GPA) are uncommon and highly variable in morphology and extension. There is no scoring system that considers all the dimensions of adenoma invasion. We developed a new Giant Pituitary Adenoma score and report our surgical experience and evaluate outcomes after resection of these tumors in accordance with the preoperative score. METHODS We developed a novel scoring system for classifying giant pituitary adenomas, and 11-year data of GPA surgery at our center was collected retrospectively, based on this scoring system. GPA Score considered tumor’s parasellar extension, encasement of cavernous internal carotid artery (ICA), suprasellar extension > 2 cm, suprasellar extension > 4cm and retrosellar extension. Maximum possible score was 9. The scoring system was applied to 53 patients of GPA who underwent surgical resection between January 1, 2006, and December 2017. The Lundin-Pederson (ABC/2) method was used to calculate the tumor volume both pre- and post-resection and linear regression was used to assess the relationship between extent of tumor resection and GPA score. RESULTS The median age of the study population was 42.08 ± 16.49 years. The mean maximum diameter of the pituitary adenomas was 5.0 cm (range 4.0 cm-8.5cm) while the mean volume of the adenomas was 27.3 cm3 (range 10 cm3-149 cm3). There were 3 cases of score 2, 5 cases of score 3, 13 cases of score 4, 20 cases of score 5, 9 cases of score 6 and 3 cases of score 7. The range of tumor volumes of tumors for scores from 2-7 was 17.3 cm3 to 65.8 cm3 and GPA score was correlated with the percent residual tumor using linear regression that was statistically significant (p= 0.001). CONCLUSION GPA Score is a reliable scoring system to predict the extent and subsequent difficulty in tumor resection in GPA.

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The Value of Computed Tomography in Delineating Suprasellar Extension of Pituitary Adenomas

Proceedings of the XI. Symposium Neuroradiologicum ◽

10.1007/978-3-642-66959-0_149 ◽

1978 ◽

pp. 462-463

Author(s):

S. Pripstein ◽

B. Danoff ◽

D. Schnapf ◽

K. F. Lee ◽

S. Kramer

Keyword(s):

Computed Tomography ◽

Pituitary Adenomas ◽

Suprasellar Extension

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The Medical Treatment of the Hypersecreting Pituitary Gland

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100047090 ◽

1985 ◽

Vol 12 (3) ◽

pp. 243-250 ◽

Cited By ~ 4

Author(s):

Bernard Corenblum

Keyword(s):

Clinical Improvement ◽

Medical Therapy ◽

Pituitary Adenomas ◽

Clinical Symptoms ◽

Pituitary Tumors ◽

Serum Prolactin ◽

Metabolic Complications ◽

Pharmacological Agents ◽

Neurological Effects ◽

Suprasellar Extension

ABSTRACT:Pituitary adenomas may produce local endocrine and neurological effects, as well as systemic metabolic complications due to hormonal hypersecretion. Medical therapy with pharmacological agents has been developed and is based on the neurotransmitter regulation of normal pituitary hormonal secretion. 189 patients with secretory pituitary adenomas underwent medical therapy for the hypersecretory state. 156 of these were prolactin-secreting adenomas, 16 of which were in males. The response of bromocriptine was almost universal with lowering of serum prolactin and reversal of the clinical symptoms, as well as tumor shrinkage of most large adenomas with suprasellar extension. 23 patients with acromegaly were treated with bromocriptine, with 11 noting clinical improvement, and decreased tumor size in two. Five patients with Cushing’s disease were treated with cyproheptadine, with only one showing a biochemical and clinical improvement. Two patients with Nelson’s syndrome each had progressive tumor growth stabilized with cyproheptadine and bromocriptine in one, and sodium valproate in the other. There appears to be a role for medical therapy in the majority of prolactin-secreting pituitary tumors, some growth hormone secreting pituitary tumors, and selected adrenocorticotropin secreting-pituitary tumors.

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Reformatted sagittal images in the differential diagnosis of meningiomas and pituitary adenomas with suprasellar extension

Neurosurgery ◽

10.1097/00006123-198605000-00007 ◽

1986 ◽

Vol 18 (5) ◽

pp. 555???8

Author(s):

W C Clark ◽

J D Acker ◽

J H Robertson ◽

F Eggers ◽

M S Muhlbauer

Keyword(s):

Differential Diagnosis ◽

Pituitary Adenomas ◽

Suprasellar Extension

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Transsphenoidal extracapsular approach to pituitary tumors

Journal of Neurosurgery ◽

10.3171/jns.1986.64.1.0016 ◽

1986 ◽

Vol 64 (1) ◽

pp. 16-20 ◽

Cited By ~ 46

Author(s):

Nobuo Hashimoto ◽

Hajime Handa ◽

Tatsuhito Yamagami

Keyword(s):

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Pituitary Tumors ◽

Hormonal Control ◽

Arachnoid Membrane ◽

Content Type ◽

Tumor Capsule ◽

Suprasellar Extension ◽

Fine Print ◽

Transsphenoidal Resection

✓ Two years' experience with an extracapsular transsphenoidal approach to pituitary adenomas is presented. Some pituitary tumors contain an inordinate amount of connective tissue that often makes transsphenoidal resection difficult. By opening the tumor capsule and adjacent arachnoid membrane, such tumors with suprasellar extension can be safely removed. In some cases of functioning adenoma, resection of the diaphragma sellae and adjacent arachnoid membrane results in hormonal control. Among 62 cases of transsphenoidal surgery for pituitary adenomas, eight cases required this procedure. The surgical procedure is described and the cases are summarized. The indication and limitations of this procedure are discussed.

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Follow-up study with computerized tomography and clinical evaluation 5 to 10 years after surgery for pituitary adenoma

Journal of Neurosurgery ◽

10.3171/jns.1980.53.2.0144 ◽

1980 ◽

Vol 53 (2) ◽

pp. 144-148 ◽

Cited By ~ 12

Author(s):

Carin Muhr ◽

Kjell Bergstrom ◽

Paul Enoksson ◽

Rune Hugosson ◽

Per Olov Lundberg

Keyword(s):

Pituitary Adenoma ◽

Computerized Tomography ◽

No Value ◽

Content Type ◽

Follow Up Study ◽

Field Defect ◽

Very High ◽

Suprasellar Extension ◽

Fine Print

✓ This study was based on 24 consecutive patients operated on for pituitary adenoma with suprasellar extension, and treated postoperatively with radiotherapy. The follow-up period was 5 to 10 years. A clinical examination, endocrine evaluation, perimetry, computerized tomography (CT) and sellar roentgenography were performed in 19 of 20 surviving patients. The CT scans revealed four recurrences, while perimetry only showed an increased visual field defect in one patient. Plain sellar films were of no value for diagnosis of recurrence. Prolactin determinations seemed to have a limited value in recurrence diagnosis, but very high levels spoke in favor of a recurrence. Thus, CT was found to be the superior method of diagnosing recurrences. It is proposed that CT be used regularly in the follow-up study of patients operated on for a pituitary adenoma.

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Computerized Tomography in the Evaluation of Pituitary Adenomas

Investigative Radiology ◽

10.1097/00004424-197701000-00010 ◽

1977 ◽

Vol 12 (1) ◽

pp. 27-35 ◽

Cited By ~ 16

Author(s):

CHARLES M. CITRIN ◽

DAVID O. DAVIS

Keyword(s):

Computerized Tomography ◽

Pituitary Adenomas

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Hemorrhagic Pituitary Adenomas: Clinicopathological Features and Surgical Treatment

Neurosurgery ◽

10.1227/00006123-199011000-00011 ◽

1990 ◽

Vol 27 (5) ◽

pp. 741-748 ◽

Cited By ~ 38

Author(s):

Bernardo Fraioli ◽

Vincenzo Esposito ◽

Lucio Palma ◽

Giampaolo Cantore

Keyword(s):

Pituitary Adenomas ◽

Pituitary Apoplexy ◽

Postoperative Radiotherapy ◽

Multidisciplinary Treatment ◽

Late Results ◽

Blood Collection ◽

Hemorrhagic Necrosis ◽

Almost All ◽

Suprasellar Extension

Abstract Forty-five (9.9%) of 453 pituitary adenomas operated on between January 1973 and November 1988 demonstrated hemorrhagic changes at surgery: 24 had a blood collection, 12 had a blood collection associated with hemorrhagic necrosis, and 9 had hemorrhagic necrosis. Thirteen patients (28.9%) experienced the acute symptoms of pituitary apoplexy, whereas another 32 had an “asymptomatic” hemorrhage, that is. the clinical course was comparable to an uncomplicated adenoma. Nineteen tumors (42.2%) showed marked suprasellar extension, 8 (17.8%) showed moderate extension, and 11 (24.5%) showed slight extension; another 2 (4.4%) were laterosellar and 5 (11.1%) were intrasellar. Invasive behavior was present in 32 cases (71.1%) and this may suggest another hypothesis to explain the pathogenesis of tumoral hemorrhage. The incidence of hemorrhagic complications in invasive adenomas with marked suprasellar extension was particularly impressive; therefore, we do not suggest preoperative bromocriptine treatment in this type of tumor. Two of 14 patients operated on by the transcranial route died after surgery. whereas there was no operative mortality in the 31 patients operated on by the transsphenoidal route. It proved advantageous to operate as early as possible, even during the acute phase of pituitary apoplexy. The transsphenoidal approach gave the best results, but to achieve satisfactory late results multidisciplinary treatment was necessary, namely, postoperative radiotherapy in 23 patients, bromocriptine in 12. and endocrine replacement therapy in almost all. In an average follow-up period of 6.2 years. 5 (11.1%) symptomatic recurrences were observed.

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