scholarly journals The outcomes of conservatively observed asymptomatic nonfunctioning pituitary adenomas with optic nerve compression

2020 ◽  
pp. 1-8
Author(s):  
Kihwan Hwang ◽  
Yong Hwy Kim ◽  
Jung Hee Kim ◽  
Jung Hyun Lee ◽  
Hee Kyung Yang ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Natural History ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Nerve Compression ◽  
Cavernous Sinus Invasion ◽  
Nonfunctioning Pituitary Adenomas ◽  
History Of ◽  
Optic Nerve Compression

OBJECTIVEThe authors investigated the natural history of asymptomatic nonfunctioning pituitary adenomas (NFPAs) with optic nerve compression.METHODSThis study retrospectively analyzed the natural history of asymptomatic NFPAs with documented optic nerve compression on MRI diagnosed between 2000 and 2016 from 2 institutions. The patients were followed up with regular endocrinological, ophthalmological, and radiological evaluations, and the endpoint was new endocrinopathy or neurological deficits.RESULTSThe study comprised 81 patients. The median age at diagnosis was 58.0 years and the follow-up duration was 60.0 months. As the denominator of overall pituitary patients, 2604 patients were treated with surgery after diagnosis at the 2 institutions during the same period. The mean initial and last measured values for tumor diameter were 23.7 ± 8.9 mm and 26.2 ± 11.4 mm, respectively (mean ± SD). Tumor growth was observed in 51 (63.0%) patients; however, visual deterioration was observed in 14 (17.3%) patients. Ten (12.3%) patients experienced endocrine deterioration. Fourteen (17.3%) patients underwent surgery for either visual deterioration (in 12 patients) or endocrine dysfunction (in 2 patients). After surgery, all patients experienced improvements in visual or hormonal function. The actuarial rates of treatment-free survival at 2, 3, and 5 years were 96.1%, 93.2%, and 85.6%, respectively. In the multivariate analysis, initial cavernous sinus invasion (HR 4.985, 95% CI 1.597–15.56; p = 0.006) was the only independent risk factor for eventual treatment.CONCLUSIONSThe neuroendocrinological deteriorations were not frequent and could be recovered by surgery with early detection on regular follow-up in asymptomatic NFPAs with documented optic nerve compression on MRI. Therefore, conservative management could be an acceptable strategy for these tumors. Careful follow-up is required for tumors with cavernous sinus invasion.

scholarly journals P14.104 The outcomes of conservatively observed asymptomatic nonfunctioning pituitary adenomas with optic nerve compression

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii92-iii92
Author(s):  
K Hwang ◽  
Y Kim ◽  
C Kim ◽  
J Han
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Pituitary Adenomas ◽  
Surgical Intervention ◽  
Tumor Resection ◽  
Nerve Compression ◽  
Nonfunctioning Pituitary Adenomas ◽  
The Mean ◽  
Optic Nerve Compression

Abstract BACKGROUND We investigated the natural history of asymptomatic nonfunctioning pituitary adenomas (NFPAs) abutting on optic nerve. MATERIAL AND METHODS Eighty-three patients with asymptomatic NFPAs with documented optic nerve compression on magnetic resonance imaging (MRI) at the time of detection between 2000 and 2016 were included in this study. Patients were evaluated with a hormone test, visual acuity test, visual field test and MRI at the time of diagnosis, and then, yearly, without any treatment (including surgery and radiation). RESULTS The mean age was 57.7±13.6 (range, 15 - 81) years. The mean follow-up duration was 66.6±39.0 (range, 12 - 184) months. Tumor volume growth ≥ 20% was observed in 64 (77.1%) patients. Ten (12.2%) patients experienced any kind of hormonal dysfunction, and gonadotropin deficiency was the most common type of hormonal deficiency [n=9 (10.8%)]. Visual deterioration quantified by Visual Impairment Scale was seen 27 (32.5%) patients. There was no statistically significant factor for tumor growth or visual aggravation. Fourteen (16.9%) patients eventually underwent tumor resection. From multivariate analysis, the significant predictors for eventual surgical intervention were cavernous sinus invasion (OR=20.95; 95% CI, 2.754–159.3; p=0.003) and last follow-up visual field defect score (OR=1.170; 95% CI, 1.049–1.305; p=0.005). All patients who underwent surgery did not experience any neurologic or endocrinological deficits postoperatively. CONCLUSION The clinical outcomes of conservatively observed NFPAs with optic nerve compression can be acceptable. The decision for surgical intervention should be made by balancing the risk and benefits.

Optimal follow-up strategy based on the natural history of nonfunctioning pituitary adenomas

2018 ◽  
Author(s):  
Kim Jung Hee ◽  
Yun-Sik Dho ◽  
Kim Yong Hwy ◽  
Lee Jung Hyun ◽  
Lee Ji Hyun ◽  
...  
Keyword(s):  
Natural History ◽  
Pituitary Adenomas ◽  
Nonfunctioning Pituitary Adenomas ◽  
History Of

Endoscopic Endonasal Management of Nonfunctioning Pituitary Adenomas with Cavernous Sinus Invasion: Our Experience

2013 ◽  
Vol 149 (2_suppl) ◽  
pp. P48-P48
Author(s):  
Fabio Ferreli ◽  
Mario Turri-Zanoni ◽  
Stefania Gallo ◽  
Maurizio Bignami ◽  
Giustino Tomei ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Endoscopic Endonasal ◽  
Cavernous Sinus Invasion ◽  
Nonfunctioning Pituitary Adenomas

scholarly journals Natural history of cavernous sinus meningiomas

2019 ◽  
Vol 130 (2) ◽  
pp. 435-442
Author(s):  
Aymeric Amelot ◽  
Remy van Effenterre ◽  
Michel Kalamarides ◽  
Philippe Cornu ◽  
Anne-Laure Boch
Keyword(s):  
Natural History ◽  
Medical Treatment ◽  
Cavernous Sinus ◽  
Incidental Findings ◽  
Survival Rates ◽  
High Growth ◽  
Benign Tumors ◽  
Growth Variability ◽  
History Of

OBJECTIVEMeningiomas confined to the cavernous sinus (MCSs) are benign tumors. Due to the high risk of severe complications, the intracavernous surgical procedure was abandoned in favor of radiotherapy. However, the choice of treatment remains complicated due to the fact that the natural history of this lesion has not yet been described.METHODSThe authors studied the natural history of this lesion using a prospective series of 53 consecutive patients suffering from MCSs. The median follow-up duration was 10.2 years (range 2–25 years), from 1990 to 2016.RESULTSPatients ranged in age from 30 to 72 years (mean 53 years). The meningiomas were diagnosed by major symptoms (mainly oculomotor palsy and neuralgia experienced in 28 patients), minor symptoms (headache, intermittent diplopia in 15 patients), or incidental findings (10 patients). Simple symptomatic treatment (short courses of corticosteroids and carbamazepine) allowed patients to become asymptomatic in 19 (67.9%) of 28 cases experiencing major symptoms, and for 12 (80%) of 15 patients with initial minor symptoms (p < 0.0001). All patients with incidental findings remained asymptomatic. Forty four (83%) of 53 MCSs did not show any significant growth and 42 (80%) of 53 patients were not symptomatic at the end of follow-up (p < 0.001). The radiographic progression-free survival rates (± SD) at 5, 10, and 20 years were 90% ± 4.2%, 82% ± 5.7%, and 70% ± 10.2%, respectively. Five patients (9.4%) with no evidence of any effect of the initial medical treatment desired additional conventional radiation therapy.CONCLUSIONSBecause of the capricious, unpredictable, and slow growth of MCSs, together with high growth variability from one patient to the next, the symptomatic medical treatment of these tumors is a highly effective method. This series shows that these lesions are naturally, clinically, and radiologically indolent.

What Is the Natural History of Nonoperated Nonfunctioning Pituitary Adenomas?

2008 ◽  
Vol 63 (4) ◽  
pp. 228-229
Author(s):  
N Karavitaki ◽  
K Collison ◽  
J Halliday ◽  
J V. Byrnet ◽  
P Price ◽  
...  
Keyword(s):  
Natural History ◽  
Pituitary Adenomas ◽  
Nonfunctioning Pituitary Adenomas ◽  
History Of

The natural history of surgically treated but radiotherapy-naïve nonfunctioning pituitary adenomas

2009 ◽  
Vol 71 (5) ◽  
pp. 709-714 ◽  
Author(s):  
Eoin P. O’Sullivan ◽  
Conor Woods ◽  
Nigel Glynn ◽  
Lucy Ann Behan ◽  
Rachel Crowley ◽  
...  
Keyword(s):  
Natural History ◽  
Pituitary Adenomas ◽  
Nonfunctioning Pituitary Adenomas ◽  
History Of

scholarly journals Natural History of Postoperative Nonfunctioning Pituitary Adenomas: A Systematic Review and Meta-Analysis

2012 ◽  
Vol 96 (4) ◽  
pp. 333-342 ◽  
Author(s):  
Yong Chen ◽  
Cheng De Wang ◽  
Zhi Peng Su ◽  
Yun Xiang Chen ◽  
Lin Cai ◽  
...  
Keyword(s):  
Systematic Review ◽  
Natural History ◽  
Pituitary Adenomas ◽  
Meta Analysis ◽  
Nonfunctioning Pituitary Adenomas ◽  
History Of

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma

2002 ◽  
Vol 97 ◽  
pp. 408-414 ◽  
Author(s):  
Jason P. Sheehan ◽  
Douglas Kondziolka ◽  
John Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Visual Fields ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Content Type ◽  
Cavernous Sinus Invasion ◽  
Nonfunctioning Pituitary Adenomas ◽  
Fine Print

Object. Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. Methods. A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. Conclusions. Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

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