PNA Medical Corner: Outcomes After Pituitary Surgery

Varun KshettryA study in World Neurosurgery coauthored by PNA member Varun Kshettry looks clinical outcomes after endoscopic endonasal resection of giant pituitary adenomas. They examined the medical records of 55 pituitary patients and found that endoscopic endonasal resection is superior to transsphenoidal and transcranial surgical methods.
World Neurosurg. 2018 Mar 12. pii: S1878-8750(18)30472-8. doi: 10.1016/j.wneu.2018.03.006. [Epub ahead of print]

Clinical Outcomes After Endoscopic Endonasal Resection of Giant Pituitary Adenomas.
Elshazly K1, Kshettry VR2, Farrell CJ3, Nyquist G4, Rosen M5, Evans JJ6.



Giant pituitary adenomas represent a surgical challenge. We present the results of the endoscopic endonasal approach (EEA) for giant pituitary adenomas.


We retrospectively reviewed medical records of 55 patients with giant pituitary adenomas (> 4 cm in maximum diameter) that underwent an EEA from 2008 - 2016. Factors affecting the extent of resection (EOR) were evaluated.


Mean age was 55.5 years. All tumors were non-functional except in four patients (GH-secreting [2], ACTH-secreting [1], prolactinoma [1]). Gross total resection was achieved in 24 (44%) and near total resection (>90%) in 26 (47%) patients. Multi-lobular configuration (p= 0.002) and cavernous sinus invasion (p= 0.044) negatively affected EOR, whereas tumor size, intraventricular, anterior and posterior fossa extension did not. Ten patients underwent adjuvant radiation. All patients with hormone-secreting adenomas required adjuvant medical and/or radiotherapy to achieve biochemical remission. Post-operative vision was improved or normalized in 32 (66%), stable in 15 (31%), and worsened in one patient. A new hormonal deficit occurred in eight (17%), whereas recovery of an existing hormonal deficit occurred in six (20%) patients. Mean follow-up was 41 months. Tumor recurrence/progression occurred in six (11%) patients. Complications included apoplexy of residual tumor resulting in ischemic stroke in one, postoperative cerebrospinal fluid leak in one, and permanent diabetes insipidus in four (7%) patients.


The EEA is an excellent option for management of giant pituitary adenomas. It results in clinical outcomes that are superior to those obtained using traditional microscopic transsphenoidal and transcranial approaches as reported in the literature.
Copyright © 2018 Elsevier Inc. All rights reserved.

Endonasal; Endoscopic; Extended approach; Giant adenomas; Pituitary tumors; Vision


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