Immediate recovery of pituitary function after transsphenoidal resection of pituitary macroadenomas.

✓ A series of 84 patients with pituitary adenomas greater than 1 cm in diameter is presented. Full preoperative and postoperative endocrine evaluations were carried out, and the effects of transsphenoidal surgery on remaining anterior pituitary function were analyzed. Of the patients who had normal anterior pituitary function before surgery, 78% retained normal function after surgery. Thirty-three percent of those patients with pituitary deficits who did not have panhypopituitarism before surgery had improved function after surgery; 33% had worsened function after surgery. None of the patients with panhypopituitarism before surgery regained function after surgery. Transsphenoidal surgery carries an acceptable risk for sacrificing anterior pituitary function, but the risk is greater in patients with larger tumors and preoperatively compromised pituitary function.

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Residual anterior pituitary function following transsphenoidal resection of pituitary macroadenomas

Prolactinomas, An interdisciplinary approach ◽

10.1515/9783110853858-037 ◽

2015 ◽

Author(s):

D. P. Becker ◽

A. T. Nelson ◽

H. St. G. Tucker

Keyword(s):

Anterior Pituitary ◽

Pituitary Function ◽

Anterior Pituitary Function ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

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Predictive Value of Cavernous Sinus Invasion on Extent of Resection Following Endoscopic Transsphenoidal Resection of Pituitary Macroadenomas

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0033-1336162 ◽

2013 ◽

Vol 74 (S 01) ◽

Author(s):

Christopher Farrell ◽

Sonia Teufack ◽

Mary Petrone ◽

Rahul Sharma ◽

Tyler Kenning ◽

...

Keyword(s):

Cavernous Sinus ◽

Predictive Value ◽

Extent Of Resection ◽

Cavernous Sinus Invasion ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

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Routine MRI Assessment Immediately Following Transsphenoidal Resection of Nonfunctional Pituitary Macroadenomas Does Not Alter the Course of Clinical Management

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0033-1336246 ◽

2013 ◽

Vol 74 (S 01) ◽

Author(s):

Christopher Farrell ◽

Mary Petrone ◽

Sonia Teufack ◽

Gurston Nyquist ◽

Mark Friedel ◽

...

Keyword(s):

Clinical Management ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

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Preservation of Normal Pituitary Function after Endoscopic Surgery for Pituitary Macroadenomas

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0035-1546481 ◽

2015 ◽

Vol 76 (S 01) ◽

Author(s):

Edward Laws ◽

Sherry Iuliano ◽

Whitney Woodmansee ◽

Liangge Hsu ◽

Charles Cho

Keyword(s):

Endoscopic Surgery ◽

Pituitary Function ◽

Pituitary Macroadenomas

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Cerebral Vasospasm After Transsphenoidal Resection of Pituitary Macroadenomas

Operative Neurosurgery ◽

10.1227/neu.0b013e31824aae21 ◽

2012 ◽

Vol 71 (suppl_1) ◽

pp. ons173-ons181 ◽

Cited By ~ 5

Author(s):

Ajit S. Puri ◽

Gabriel Zada ◽

Hekmat Zarzour ◽

Edward Laws ◽

Kai Frerichs

Keyword(s):

Cerebral Vasospasm ◽

De Novo ◽

Early Recognition ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Significant Risk ◽

Neurological Deficits ◽

Delayed Cerebral Vasospasm ◽

Neurological Morbidity ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

Abstract BACKGROUND: Delayed ischemic events due to vasospasm are a well-known complication of aneurysmal subarachnoid hemorrhage (SAH). Severe vasospasm in other neurosurgical settings is not as well recognized. Delay in diagnosis and treatment of vasospasm in such settings may be associated with significant neurological morbidity. OBJECTIVE: To present three cases of symptomatic delayed cerebral vasospasm after transsphenoidal resection of pituitary macroadenomas. METHODS: Transsphenoidal resection in all cases was complicated by peritumoral hemorrhage with extension into the subarachnoid space. Two of the 3 patients required re-operation to evacuate the hematoma in the tumor bed because of progressive worsening neurological deficits. RESULTS: All 3 patients developed vasospasm of the intracranial vessels, starting as early as postoperative day 5 and appearing as late as postoperative day 10. Comparisons to the non-vascular pre-operative magnetic resonance imaging studies confirmed the “de-novo” nature of the vasospasm based on the caliber of the flow voids. CONCLUSION: Transsphenoidal surgery complicated by peritumoral hemorrhage is associated with a significant risk of neurological morbidity because of delayed cerebral vasospasm. Early recognition and management according to guidelines used for postaneurysmal SAH may help to improve outcomes in these patients.

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Early versus late Gamma Knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study

Journal of Neurosurgery ◽

10.3171/2015.5.jns15581 ◽

2016 ◽

Vol 125 (1) ◽

pp. 202-212 ◽

Cited By ~ 13

Author(s):

I. Jonathan Pomeraniec ◽

Robert F. Dallapiazza ◽

Zhiyuan Xu ◽

John A. Jane ◽

Jason P. Sheehan

Keyword(s):

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Expectant Management ◽

Pituitary Insufficiency ◽

Increased Risk ◽

Late Treatment ◽

Early Cohort ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

OBJECT Gamma Knife radiosurgery (GKRS) is frequently employed to treat residual or recurrent nonfunctioning pituitary macroadenomas. There is no consensus as to whether GKRS should be used early after surgery or if radiosurgery should be withheld until there is evidence of radiographic progression of tumor. METHODS This is a retrospective review of patients with nonfunctioning pituitary macroadenomas who underwent transsphenoidal surgery followed by GKRS between 1996 and 2013 at the University of Virginia Health System. Patients were stratified based on the interval between resection and radiosurgery. Operative results and imaging and clinical outcomes were compared across groups following early (≤ 6 months) or late (> 6 months) radiosurgery. RESULTS Sixty-four patients met the study criteria and were grouped based on early (n = 32) or late (n = 32) GKRS following transsphenoidal resection. There was a greater risk of tumor progression after GKRS in the late radiosurgical group (p = 0.027) over a median radiographic follow-up period of 68.5 months. Furthermore, there was a significantly higher occurrence of post-GKRS endocrinopathy in the late radiosurgical cohort (p = 0.041). Seventeen percent of patients without endocrinopathy in the early cohort developed new endocrinopathies during the follow-up period versus 64% in the late cohort (p = 0.036). This difference was primarily due to a significantly higher rate of tumor growth during the observation period of the late treatment cohort (p = 0.014). Of these patients with completely new endocrinopathies, radiation-associated pituitary insufficiency developed in 1 of 2 patients in the early group and in 3 of 7 (42.9%) patients in the late group. CONCLUSIONS Early treatment with GKRS appears to decrease the rate of radiographic and symptomatic progression of subtotally resected nonfunctioning pituitary macroadenomas compared with late GKRS treatment after a period of expectant management. Delaying radiosurgery may place the patient at increased risk for adenoma progression and endocrinopathy.

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Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function

Neurosurgical FOCUS ◽

10.3171/foc.1997.3.1.1 ◽

1997 ◽

Vol 3 (1) ◽

pp. E1

Author(s):

R. Bryan Mason ◽

Lynnette K. Nieman ◽

John L. Doppman ◽

Edward H. Oldfield

Keyword(s):

Postoperative Period ◽

Cushing’S Disease ◽

Pituitary Tumors ◽

Optic Chiasm ◽

Anterior Lobe ◽

Pituitary Function ◽

Pituitary Stalk ◽

Cushing's Disease ◽

Suprasellar Cistern ◽

Transsphenoidal Resection

When the surgeon identifies an adenoma within the gland and selectively excises it, endocrine-active pituitary tumors are usually cured and pituitary function is preserved. Occasionally ectopic adenomas arise primarily in the pituitary stalk or arise superiorly in the midportion of the anterior lobe and extend upward within the stalk. To determine if these tumors can be selectively excised with preservation of pituitary function, the authors examined the outcome of selective adenomectomy in 10 patients with Cushing's disease with an ectopic adenoma originating in, and confined to, the stalk (four microadenomas) or an adenoma extending superiorly through the diaphragma sella and into the stalk (five microadenomas and one macroadenoma) from an operative series of 516 patients with Cushing's disease. To reach the adenoma transsphenoidally in these patients, the diaphragma sella was incised anteroposteriorly in the midline to the anterior edge of the stalk, the suprasellar cistern was entered, and the adenoma was selectively excised using care to limit injury to the infundibulum. After selective adenomectomy, Cushing's disease remitted in all patients. All patients were hypocortisolemic immediately after surgery and required hydrocortisone for up to 21 months. Apart from the adrenal axis, pituitary function was normal in five patients in the immediate postoperative period, including two patients with tumors confined to the stalk and three patients with preoperative hypothyroidism (one patient) and/or hypogonadism (three patients). Three others with transient postoperative hypothyroidism (one patient) or diabetes insipidus (two patients) had normal pituitary function within 7 months of surgery. One patient with hypothyroidism and one with hypogonadism before surgery had panhypopituitarism postoperatively. A patient with a microadenoma located high in the stalk next to the optic chiasm had bitemporal hemianopsia postoperatively. These results demonstrate the feasibility of achieving curative transsphenoidal resection and preservation of pituitary function in cases of pituitary adenomas that are confined to the pituitary stalk or tumors that extend superiorly within the stalk from an intrasellar origin.

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