Surgical, Radiological, and Endocrinological Cure in Either Hormonally Active or Nonfunctional Invasive Pituitary Adenomas with Radical Surgical Removal

Skull Base ◽  
2009 ◽  
Vol 19 (03) ◽  
Author(s):  
Ali Krisht ◽  
Kuo-Hsing Liao
Keyword(s):  
Pituitary Adenomas ◽  
Surgical Removal

Extended transsphenoidal approach for pituitary adenomas invading the anterior cranial base, cavernous sinus, and clivus: a single-center experience with 126 consecutive cases

2010 ◽  
Vol 112 (1) ◽  
pp. 108-117 ◽  
Author(s):  
Bing Zhao ◽  
Yu-Kui Wei ◽  
Gui-Lin Li ◽  
Yong-Ning Li ◽  
Yong Yao ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Tumor Resection ◽  
Cranial Base ◽  
Transsphenoidal Approach ◽  
Preoperative Imaging ◽  
Surgical Removal ◽  
Extended Transsphenoidal Approach ◽  
Anterior Cranial Base

Object The standard transsphenoidal approach has been successfully used to resect most pituitary adenomas. However, as a result of the limited exposure provided by this procedure, complete surgical removal of pituitary adenomas with parasellar or retrosellar extension remains problematic. By additional bone removal of the cranial base, the extended transsphenoidal approach provides better exposure to the parasellar and clival region compared with the standard approach. The authors describe their surgical experience with the extended transsphenoidal approach to remove pituitary adenomas invading the anterior cranial base, cavernous sinus (CS), and clivus. Methods Retrospective analysis was performed in 126 patients with pituitary adenomas that were surgically treated via the extended transsphenoidal approach between September 1999 and March 2008. There were 55 male and 71 female patients with a mean age of 43.4 years (range 12–75 years). There were 82 cases of macroadenoma and 44 cases of giant adenoma. Results Gross-total resection was achieved in 78 patients (61.9%), subtotal resection in 43 (34.1%), and partial resection in 5 (4%). Postoperative complications included transient cerebrospinal rhinorrhea (7 cases), incomplete cranial nerve palsy (5), panhypopituitarism (5), internal carotid artery injury (2), monocular blindness (2), permanent diabetes insipidus (1), and perforation of the nasal septum (2). No intraoperative or postoperative death was observed. Conclusions The extended transsphenoidal approach provides excellent exposure to pituitary adenomas invading the anterior cranial base, CS, and clivus. This approach enhances the degree of tumor resection and keeps postoperative complications relatively low. However, radical resection of tumors that are firm, highly invasive to the CS, or invading multidirectionally remains a big challenge. This procedure not only allows better visualization of the tumor and the neurovascular structures but also provides significant working space under the microscope, which facilitates intraoperative manipulation. Preoperative imaging studies and new techniques such as the neuronavigation system and the endoscope improve the efficacy and safety of tumor resection.

RECOVERY OF PITUITARY FUNCTION FOLLOWING SURGICAL REMOVAL OF LARGE NONFUNCTIONING PITUITARY ADENOMAS

1982 ◽  
Vol 17 (3) ◽  
pp. 213-222 ◽  
Author(s):  
BAHA'UDDIN M. ARAFAH ◽  
JERALD S. BRODKEY ◽  
ANDREA MANNI ◽  
MANUEL E. VELASCO ◽  
BENJAMIN KAUFMAN ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Pituitary Function ◽  
Surgical Removal ◽  
Nonfunctioning Pituitary Adenomas

scholarly journals Radiosurgical treatment of residual and recurrent pituitary adenomas

2021 ◽  
Vol 35 (1) ◽  
pp. 26-32
Author(s):  
O.M. Voznyak ◽  
O.S. Silaieva ◽  
M.Ye. Polishchuk ◽  
N.O. Hryniv
Keyword(s):  
Pituitary Adenomas ◽  
Size Control ◽  
Residual Tumor ◽  
Endocrine Function ◽  
Treatment Result ◽  
Surgical Removal ◽  
High Dose ◽  
Negative Effects ◽  
Treatment Start ◽  
The Mean

Objective ‒ the treatment result estimation of subtotally removed and recurrent pituitary adenomas using different algorithms of radiotherapy and radiosurgery.Materials and methods. The retrospective analysis of 21 cases of pituitary adenomas was performed. There were 11 women and 10 men included. The average age was 45 (from 18 to 72) years. All patients had relapse or residual tumor after incomplete surgical removal. The method of irradiation was chosen by a radiologist. Tumor size control was assessed by an independent radiologist in 3 months and 1 year after treatment. Endocrine function was estimated by an independent endocrinologist in 3 months and 1 year after treatment.Results. Following transsphenoidal removal ‒ 13 patients (4 were operated twice), 5 after cranial surgery and 3 were operated sequentially transnasally and transcranially. Irradiation of 14 cases of residual tumor was performed no later than 6 months after surgery. The mean term of treatment start of recurrent adenomas was 12 months (8‒17) after surgery. VARIAN Novalis was applied in 16 cases, VARIAN Clinac iX in 4 cases and VARIAN TrueBeam STx was used once. Single and total radiation doses were determined individually. None of patients had visual impairment after treatment. The hypopituitarism deterioration was not noted as well.Conclusions. Hypofractionated stereotactic radiosurgery allows to bring a high dose of radiation to the pituitary adenomas, minimizing damage to the visual pathways, the pituitary gland and infundibulum. As the sequence, it reduces the toxicity of the technique. The application of modern radiation technologies minimize the irradiation of healthy surrounding tissues and reduce the negative effects of treatment.

scholarly journals Nkx3-1 and Fech genes might be switch genes involved in pituitary non-functioning adenoma invasiveness

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Nasibeh Khayer ◽  
Maryam Jalessi ◽  
Amin Jahanbakhshi ◽  
Alireza Tabib khooei ◽  
Mehdi Mirzaie
Keyword(s):  
Pituitary Adenomas ◽  
Molecular Mechanisms ◽  
Target Genes ◽  
Sella Turcica ◽  
Interaction Model ◽  
Surgical Removal ◽  
Mortality And Morbidity ◽  
Liquid Association ◽  
Novel Therapeutic Strategies ◽  
First Time

AbstractNon-functioning pituitary adenomas (NFPAs) are typical pituitary macroadenomas in adults associated with increased mortality and morbidity. Although pituitary adenomas are commonly considered slow-growing benign brain tumors, numerous of them possess an invasive nature. Such tumors destroy sella turcica and invade the adjacent tissues such as the cavernous sinus and sphenoid sinus. In these cases, the most critical obstacle for complete surgical removal is the high risk of damaging adjacent vital structures. Therefore, the development of novel therapeutic strategies for either early diagnosis through biomarkers or medical therapies to reduce the recurrence rate of NFPAs is imperative. Identification of gene interactions has paved the way for decoding complex molecular mechanisms, including disease-related pathways, and identifying the most momentous genes involved in a specific disease. Currently, our knowledge of the invasion of the pituitary adenoma at the molecular level is not sufficient. The current study aimed to identify critical biomarkers and biological pathways associated with invasiveness in the NFPAs using a three-way interaction model for the first time. In the current study, the Liquid association method was applied to capture the statistically significant triplets involved in NFPAs invasiveness. Subsequently, Random Forest analysis was applied to select the most important switch genes. Finally, gene set enrichment (GSE) and gene regulatory network (GRN) analyses were applied to trace the biological relevance of the statistically significant triplets. The results of this study suggest that “mRNA processing” and “spindle organization” biological processes are important in NFAPs invasiveness. Specifically, our results suggest Nkx3-1 and Fech as two switch genes in NFAPs invasiveness that may be potential biomarkers or target genes in this pathology.

scholarly journals Initial Gamma Knife radiosurgery for nonfunctioning pituitary adenomas

2014 ◽  
Vol 120 (3) ◽  
pp. 647-654 ◽  
Author(s):  
Cheng-Chia Lee ◽  
Hideyuki Kano ◽  
Huai-Che Yang ◽  
Zhiyuan Xu ◽  
Chun-Po Yen ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Pituitary Adenomas ◽  
Gamma Knife Radiosurgery ◽  
Outcome Data ◽  
Tumor Control ◽  
Surgical Removal ◽  
Tumor Margin ◽  
Tumor Control Rate ◽  
Nonfunctioning Pituitary Adenomas

Object Nonfunctioning pituitary adenomas (NFAs) are the most common type of pituitary adenoma and, when symptomatic, typically require surgical removal as an initial means of management. Gamma Knife radiosurgery (GKRS) is an alternative therapeutic strategy for patients whose comorbidities substantially increase the risks of resection. In this report, the authors evaluated the efficacy and safety of initial GKRS for NFAs. Methods An international group of three academic Gamma Knife centers retrospectively reviewed outcome data in 569 patients with NFAs. Results Forty-one patients (7.2%) underwent GKRS as primary management for their NFAs because of an advanced age, multiple comorbidities, or patient preference. The median age at the time of radiosurgery was 69 years. Thirty-seven percent of the patients had hypopituitarism before GKRS. Patients received a median tumor margin dose of 12 Gy (range 6.2–25.0 Gy) at a median isodose of 50%. The overall tumor control rate was 92.7%, and the actuarial tumor control rate was 94% and 85% at 5 and 10 years postradiosurgery, respectively. Three patients with tumor growth or symptom progression underwent resection at 3, 3, and 96 months after GKRS, respectively. New or worsened hypopituitarism developed in 10 patients (24%) at a median interval of 37 months after GKRS. One patient suffered new-onset cranial nerve palsy. No other radiosurgical complications were noted. Delayed hypopituitarism was observed more often in patients who had received a tumor margin dose > 18 Gy (p = 0.038) and a maximum dose > 36 Gy (p = 0.025). Conclusions In this study, GKRS resulted in long-term control of NFAs in 85% of patients at 10 years. This experience suggests that GKRS provides long-term tumor control with an acceptable risk profile. This approach may be especially valuable in older patients, those with multiple comorbidities, and those who have endocrine-inactive tumors without visual compromise due to mass effect of the adenoma.

scholarly journals Nkx3-1 and Fech Genes Might be Switch Genes Involved in Pituitary Non-Functioning Adenoma Invasiveness

2021 ◽  
Author(s):  
Nasibeh Khayer ◽  
Maryam Jalessi ◽  
Amin Jahanbakhshi ◽  
Alireza Tabib khooei ◽  
Mehdi Mirzaie
Keyword(s):  
Pituitary Adenomas ◽  
Molecular Mechanisms ◽  
Target Genes ◽  
Sella Turcica ◽  
Interaction Model ◽  
Surgical Removal ◽  
Mortality And Morbidity ◽  
Liquid Association ◽  
Novel Therapeutic Strategies ◽  
First Time

Abstract Non-functioning pituitary adenomas (NFPAs) are typical pituitary macroadenomas in adults that are associated with increased mortality and morbidity. Although pituitary adenomas are commonly considered slow-growing benign brain tumors, numerous of them possess an invasive nature. Such tumors destroy sella turcica and invade the adjacent tissues such as the cavernous sinus and sphenoid sinus. The most critical obstacle for complete surgical removal in these cases is the high risk of damaging adjacent vital structures. Therefore, the development of novel therapeutic strategies for either early diagnosis through biomarkers or medical therapies to reduce the recurrence rate of NFPAs is imperative. Identification of gene interactions has paved the way for decoding complex molecular mechanisms, including disease-related pathways, and identifying the most momentous genes involved in a specific disease. Currently, our knowledge of the invasion of the pituitary adenoma at the molecular level is not sufficient. The current study aimed to identify critical biomarkers and biological pathways associated with invasiveness in the NFPAs using a three-way interaction model for the first time. In the current study, the Liquid association method was applied to capture the statistically significant triplets that are involved in NFPAs invasiveness. Subsequently, Random Forest analysis was applied to select the most important switch genes. Finally, gene set enrichment (GSE) and gene regulatory network (GRN) analyses were applied to trace the biological relevance of the statistically significant triplets. The results of this study suggest that “mRNA processing” and “spindle organization” biological processes are important in NFAPs invasiveness. Specifically, our results suggest Nkx3-1 and Fech as two switch genes in NFAPs invasiveness that may be a potential biomarkers or target genes, in this pathology.

scholarly journals Outcome of visual acuity after surgical removal of pituitary adenomas

2013 ◽  
Vol 141 (5-6) ◽  
pp. 296-303 ◽  
Author(s):  
Desanka Grkovic ◽  
Tatjana Bedov
Keyword(s):  
Visual Acuity ◽  
Prognostic Factors ◽  
Tumor Size ◽  
Pituitary Adenomas ◽  
Tumor Resection ◽  
Visual Outcome ◽  
Surgical Removal ◽  
Moderate Degree ◽  
Duration Of Symptoms ◽  
Chisquare Test

Introduction. Pituitary adenomas with suprasellar extension may produce anterior visual pathway compression, resulting in characteristic visual deficit. Surgical decompression of these structures prevents further visual deterioration and its postop? erative recovery. Objective. The aim of this study was to investigate pre? and postoperative visual acuity (VA) in patients with pituitary ad? enomas, and to detect the influence of prognostic factors, such as symptoms duration, degree of visual acuity reduction and tumor size in the assessment of the prognosis of postoperative visual function. Methods. We analyzed 40 consecutive patients who fulfilled three criteria: evidence of preoperative visual dysfunction, transsphenoidal or transfrontal tumor resection and hystologically verified pituitary adenoma. A visual examination was performed under standard conditions, pre and postoperatively (10 days, one month and six months after surgery). A paired t?test was used to assess the differences of pre? and postoperative characteristics values, and the Chisquare test of independence in the assessment of the influence of prognostic factors. Results. Postoperative improvement of VA was seen in 84.61% patients (68% eyes). Eyes with preoperative mild and moderate degree of VA reduction showed improvement in 89.65% eyes in contrast to 22.60% eyes with preoperative severe reduction of VA, which was all statistically significant. Eyes in patients with tumor smaller than 20 mm had improvement of VA in 91.66% eyes, while eyes with tumor larger than 40 mm had improvement of VA in 61.11% eyes, which was statistically significant. When symptoms duration was below two years the improvement of VA was detected in 65.38% eyes as related to 50% eyes with symptoms duration exceeding two years, which was not statistically significant. Conclusion. Pituitary adenomas commonly cause visual impairment. Postoperatively the majority of patients show a distinct improvement of visual acuity. The degree of preoperative visual loss and tumor size influence the final visual outcome, and not the duration of symptoms.

scholarly journals Outcomes of Transsphenoidal Surgery in Growth Hormone-Secreting Pituitary Adenomas

2021 ◽  
Author(s):  
Oleksandr Voznyak ◽  
Andrii Lytvynenko ◽  
Oleg Maydannyk ◽  
Roman Ilyuk ◽  
Yaroslav Zinkevych ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenomas ◽  
Senior Author ◽  
Oral Glucose ◽  
Surgical Removal ◽  
Metabolic Disturbances ◽  
Systemic Impact ◽  
Oral Glucose Tolerance Tests ◽  
Mortality Ratio ◽  
Glucose Tolerance Tests

AbstractGrowth hormone (GH)-secreting pituitary adenomas (PA) make up 15 to 20% of total amount of hormonally active adenomas. In addition to acromegaly and gigantism, these tumors cause deep metabolic disturbances. Its systemic impact leads to increased mortality ratio of 1.32 compared with general population. Surgical removal remains the priority treatment option in controlling acromegaly and provides endocrinologic remission in up to 72% patients. A total of 92 patients were included in the study. All surgeries were performed via microscopic transsphenoidal approach (TSA) by the senior author in our institution between December 2009 and October 2019. Only patients who were followed-up with 75 g oral glucose tolerance tests (OGTTs), GH, and insulin-like growth factor I (IFG-I) measurements preoperatively, 1 week, and every 6 months postoperatively were analyzed. Based on standard preoperative 1.5-T MR imaging with contrast enhancement, the adenomas were identified and distributed according to the size and KNOSP classification. The efficacy depends on KNOSP grade, which is directly correlated with invasiveness to cavernous sinus (CS). Grades 3 and 4 are unfavorable factors influencing prognosis. Excluding grade 0 adenomas, as the surgery was not difficult with the excellent outcomes, we reached 75% (36 out of 48) remission in grade 1 to 2 groups. In contrast, only 17% (2 out of 12) had successful outcomes after surgery alone. In conclusion, the study demonstrates the efficiency of TS surgery in patients with confirmed GH-secreting PA.

Ophthalmologic Aspects of Pituitary Apoplexy

1996 ◽  
Vol 6 (1) ◽  
pp. 69-73 ◽  
Author(s):  
S. Milazzo ◽  
P. Toussaint ◽  
F. Proust ◽  
G. Touzet ◽  
D. Malthieu
Keyword(s):  
Retrospective Study ◽  
Pituitary Adenoma ◽  
Medical Treatment ◽  
Ct Scan ◽  
Pituitary Adenomas ◽  
Emergency Treatment ◽  
Pituitary Apoplexy ◽  
Surgical Removal ◽  
Visual Abnormalities ◽  
Visual Disturbances

Pituitary apoplexy is an acute hemorragic or ischemic infarction in pituitary adenomas. The incidence in our series was 6.5%. Clinical diagnosis can often be difficult as the patient is frequently unaware of an existing adenoma (seven out of 11 patients). Therefore, the classic features of the syndrome must be known. They include sudden headaches, impairment of consciousness, endocrinological disturbances and sudden visual deterioration or oculomotor palsies. In this retrospective study from 1987 to 1994 of 14 patients presenting pituitary apoplexy there were 11 cases with visual abnormalities. Oculomotor palsies were more common (82%) than chiasmatic impairment (54.5%) and often revealed pituitary adenoma. CT-Scan and MRI examinations led to diagnosis, and emergency treatment (surgical removal by rhinoseptal approach or less often medical treatment) generally led to a regression of visual disturbances.

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