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Transsphenoidal microsurgical removal of large pituitary adenomas
1Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
Objective:
To retrospectively analyze the diagnostic modes, transsphenoidal microsurgical technique and outcomes of 145 patients with pituitary macroadenoma or giant pituitary adenoma.
Methods:
A total of 145 patients suffering from pituitary macroadenoma or giant pituitary adenoma with suprasellar extension were performed with transsphenoidal microsurgery in our department. Diagnoses were made by CT or MRI scanning. All adenomas had suprasellar extension (extension size: > 10 mm). Operations were performed via either sublabio-septo-sphenoidal approach or naso-vestibulo-sphenoidal approach under microscope. During operation, a subarachnoid catheter was inserted into the lumbar cistern, via the catheter saline was slowly injected to increase the intracranial pressure (ICP) and to deliver the suprasellar tumor into the operative field for easy removal.
Results:
The gross total removal of adenoma in 102 patients (70.4%) and subtotal removal in 35 patients (24.1%) were achieved; partial removal was carried out in the remaining 8 patients (5.5%) with fibrous or dumbbell-shaped adenomas. There were no deaths after surgery. Long-term follow-up observation (median: 3.5 years) in 132 patients revealed good recovery in 93 (70.5%) and late recurrence in 39 (29.5%). Those patients with tumor recurrence underwent reoperation, drug therapy, radiotherapy, and radiosurgery either alone or in combination.
Conclusion:
Except for fibrous and dumbbell-shaped ones, microsurgical technique via transsphenoidal approach is a safe and effective way to remove large pituitary adenomas.
Insights
Transsphenoidal microsurgery is a safe and effective method for removing pituitary macroadenomas and giant pituitary adenomas. This technique achieved high gross total removal rates and good long-term recovery in most patients.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Pituitary macroadenomas and giant pituitary adenomas present significant surgical challenges.
- Suprasellar extension is common in these large pituitary tumors.
Purpose of the Study:
- To analyze diagnostic methods, transsphenoidal microsurgical techniques, and outcomes.
- Evaluate the efficacy and safety of transsphenoidal microsurgery for large pituitary adenomas.
Main Methods:
- Retrospective analysis of 145 patients with pituitary macroadenoma or giant pituitary adenoma.
- Diagnosis using CT or MRI; transsphenoidal microsurgery via sublabio-septo-sphenoidal or naso-vestibulo-sphenoidal approach.
- Intracranial pressure management using lumbar cistern catheterization and saline injection.
Main Results:
- Gross total removal achieved in 70.4% of patients; subtotal removal in 24.1%.
- No surgical deaths; 70.5% good recovery in long-term follow-up (median 3.5 years).
- Recurrence observed in 29.5%, managed with reoperation, drug therapy, or radiotherapy.
Conclusions:
- Transsphenoidal microsurgery is safe and effective for most large pituitary adenomas.
- The technique is particularly successful for non-fibrous and non-dumbbell-shaped adenomas.
- Microsurgical approach offers good outcomes for pituitary macroadenomas with suprasellar extension.