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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
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Non-functioning pituitary macro-incidentalomas benefit from early surgery before becoming symptomatic.
Mahmoud Messerer1, Julie Dubourg, Gérald Raverot
1Département de Neurochirurgie, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland.
Clinical Neurology and Neurosurgery
|November 23, 2013
Summary
Surgery for asymptomatic pituitary incidentalomas (PIs) leads to better outcomes. Asymptomatic patients experienced higher gross total removal rates and fewer postoperative impairments compared to symptomatic ones.
Area of Science:
- Endocrinology
- Neurosurgery
- Oncology
Background:
- Pituitary incidentalomas (PIs) are common clinical findings.
- Management of symptomatic non-functioning PIs (NFPIs) is established.
- Therapeutic options for asymptomatic macro-NFPIs remain debated, with surgery versus observation being the main controversy.
Purpose of the Study:
- To compare surgical outcomes between symptomatic and asymptomatic macro-NFPIs.
- To evaluate the impact of preoperative symptoms on surgical results and postoperative complications.
Main Methods:
- Retrospective study of 76 patients with macro-NFPIs operated between 2001 and 2010.
- Comparison of age, tumor size, and surgical outcomes between symptomatic and asymptomatic groups.
- Analysis of gross total removal (GTR) rates and postoperative impairments.
Main Results:
- Gross total removal (GTR) was higher in asymptomatic (82%) vs. symptomatic (58%) patients (p=0.03).
- Postoperative endocrinological impairment was significantly less frequent in asymptomatic patients (14% vs. 78%).
- Postoperative visual impairment was absent in asymptomatic patients compared to 49% in symptomatic ones.
Conclusions:
- Surgical intervention for asymptomatic macro-NFPIs yields superior endocrinological and visual outcomes.
- Higher GTR rates were observed in asymptomatic patients.
- Surgery should be considered for patients with asymptomatic macro-NFPIs.
