Transcranial approaches for pituitary adenomas: current indications and clinical and radiological outcomes

Springer Science and Business Media LLC - 2021
Mohamed Salama1, Mohamed Reda Rady1
1Department of Neurosurgery, Faculty of Medicine, Cairo University, 57 Sudan St., Cairo, Egypt

Tóm tắt

Abstract Background The indications of transcranial approaches for pituitary adenomas have declined in the last decades with the widespread performance of endoscopic transsphenoidal approaches. The aim of the study was to review the current indications of transcranial approaches for pituitary adenomas and to evaluate the clinical and radiological outcome following these approaches. Patients and methods This study included 16 patients with fresh, residual, or recurrent pituitary adenomas operated upon by transcranial approaches alone or in combination with transsphenoidal approaches. The indication to perform a transcranial approach was reviewed for each patient. Postoperative clinical outcome and the extent of tumor resection were assessed. Results The indications of transcranial approaches were significant parasellar and/or anterior fossa extensions in 6 patients, failed previous transsphenoidal surgery in 3 patients, giant adenoma extending into the third ventricle in 3 patients, dumbbell-shaped adenoma in 2 patients, and doubtful diagnosis in 2 patients. Two patients with invasive giant adenomas were operated upon by a combined approach. There was a single mortality. Permanent complications included visual loss in one patient, third nerve palsy in one patient, hypopituitarism in two patients, and permanent diabetes insipidus in two patients. Gross total resection was achieved in one patient, subtotal resection in seven patients, and partial resection in eight patients. Conclusion Transcranial approaches are still needed for some complex pituitary adenomas particularly giant tumors with significant lateral, anterior, or superior extensions, tumors with fibrous consistency particularly after failure of transsphenoidal approach, and dumbbell-shaped tumors with severe constriction at the diaphragm.

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Tài liệu tham khảo

Jho HD, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg. 1997;87(1):44–51. https://doi.org/10.3171/jns.1997.87.1.0044.

Cappabianca P, Cavallo LM, de Divitiis E. Endoscopic endonasal transsphenoidal surgery. Neurosurgery. 2004;55(4):933–41. https://doi.org/10.1227/01.NEU.0000137330.02549.0D.

Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Thomas A, Gardner P, et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors’ initial 800 patients. J Neurosurg. 2011;114(6):1544–68. https://doi.org/10.3171/2010.10.JNS09406.

Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus. 2005;19:E3.

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

Jane JA Jr, Thapar K, Laws ER Jr. Pituitary tumors: functioning and nonfunctioning. In: Winn HR, editor. Youmans Neurological Surgery. 6th ed. Philadelphia: Saunders; 2011. p. 1476–510.

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.

Koutourousiou M, Gardner P, 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.

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.

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.

Couldwell WT. Transsphenoidal and transcranial surgery for pituitary adenomas. J Neurooncol. 2004;69(1-3):237–56. https://doi.org/10.1023/B:NEON.0000041886.61149.ab.

Ojha BK, Husain M, Rastogi M, Chandra A, Chugh A, Husain N. Combined trans-sphenoidal and simultaneous trans-ventricular-endoscopic decompression of a giant pituitary adenoma: case report. Acta Neurochir (Wien). 2009;151(7):843–7. https://doi.org/10.1007/s00701-009-0336-z.

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.

Recinos PF, Goodwin CR, Brem H, Quinones-Hinojosa A. Transcranial surgery for pituitary macroadenomas. In: Quinones-Hinojosa A, editor. Schmidek & Sweet Operative Neurosurgical Techniques, ed 6th. Philadelphia: Elsevier Saunders; 280. p. 291–2012.

Ikeda H, Jokura H, Yoshimoto T. Transsphenoidal surgery and adjuvant gamma knife treatment for growth hormone-secreting pituitary adenoma. J Neurosurg. 2001;95(2):285–91. https://doi.org/10.3171/jns.2001.95.2.0285.

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.

Cappabianca P, Cavallo LM, Esposito F, De Divitiis O, Messina A, De Divitiis E. Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery. Adv Tech Stand Neurosurg. 2008;33:151–99. https://doi.org/10.1007/978-3-211-72283-1_4.

Schwartz TH, Fraser JF, Brown S, Tabaee A, Kacker A, Anand VK. Endoscopic cranial base surgery: classification of operative approaches. Neurosurgery. 2008;62(5):991–1005. https://doi.org/10.1227/01.neu.0000325861.06832.06.

Kaptain GJ, Vincent DA, Sheehan JP, Laws ER. Transsphenoidal approaches for the extracapsular resection of midline suprasellar and anterior cranial base lesions. Neurosurgery. 2008;62(6 Suppl 3):1264–71. https://doi.org/10.1227/01.neu.0000333791.29091.83.

Adams C. Transcranial surgery for pituitary macroadenomas. In Schmidek HH (ed): Schmidek and Sweet’s Operative Neurosurgical Techniques. Indications, Methods, and Results. 5th ed. Philadelphia: Saunders; 2005. p. 348–54.

Jane JA, Han J, Prevedello DM, Jagannathan J, Dumont AS, Laws ER. Perspectives on endoscopic transsphenoidal surgery. Neurosurg Focus. 2005;19:E2.

Guo F, Song L, Bai J, Zhao P, Sun H, Liu X, et al. Successful treatment for giant pituitary adenomas through diverse transcranial approaches in a series of 15 consecutive patients. Clin Neurol Neurosurg. 2012;114(7):885–90. https://doi.org/10.1016/j.clineuro.2012.01.033.

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.

Komotar RJ, Starke RM, Raper DMS, 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.

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