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Updated: Mar 28, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Nonfunctioning giant pituitary adenomas: Invasiveness and recurrence
José Alberto Landeiro1, Elissa Oliveira Fonseca2, Andrea Lima Cruz Monnerat2
1Department of Neurosurgery, Hospital Universitário Antônio Pedro, Rio de Janeiro, Brazil.
Background:
We report our surgical series of 35 patients with giant nonfunctioning pituitary adenomas (GNFPA). We analyzed the rule of Ki-67 antigen expression in predicting recurrence.
Methods:
Thirty-five patients were operated between 2000 and 2010. Suprassellar extension of the tumors were classified according to Hardy and Mohr based on magnetic resonance (MR) studies. Pituitary endocrine function and MR scans were assessed preoperatively and at 1, 6, and 12 months postoperatively. Immunohistochemical studies were based in regard to the expression of the proliferative Ki-67 index and the hormonal receptor for luteinizing hormone, follicle stimulating hormone, growth hormone, thyroid stimulating hormone, adrenocorticotropic hormone, and prolactin. Tumors specimens were obtained from 35 patients with GNFPA. Endoscopic transsphenoidal surgery was the approach of choice.
Results:
Thirty-five patients were submitted to 49 surgeries, 44 (89.8%) were transsphenoidal and 5 (10.2%) were transcranial. The most frequent preoperative complaints were visual acuity impairment and visual field defect in 25 (71.2%) and 23 (65.7%) cases, respectively. Improvement of visual acuitiy and visual field deficit after surgery was seen in 20 (80%) and 17 (73.9%) patients, respectively. Endocrinological deficits were encountered in 20 patients (57.1%). After surgery, 18 patients (51.4%) required hormonal replacement. Three patients had visual symptoms related to pituitary apoplexy and recovered after surgery. The Ki-67 labeling index (LI) ranged from <1% to 4.8%. The rate of recurrence in tumors with Ki-67 <3% was 7.7% (2 patients), Ki-67 >3% was present in 5 patients and the recurrence committed 3 patients.
Conclusion:
In our series, regardless the improvement of visual function and compressing symptoms, 5 patients with expression of Ki-67 LI more than 3% experienced a recurrence.
Insights
Giant nonfunctioning pituitary adenomas (GNFPAs) can recur, especially when the Ki-67 antigen expression is over 3%. This study analyzed 35 GNFPA cases to understand recurrence predictors.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Giant nonfunctioning pituitary adenomas (GNFPA) present unique surgical challenges.
- Understanding predictors of recurrence is crucial for patient management.
Purpose of the Study:
- To analyze the surgical outcomes in 35 patients with GNFPA.
- To evaluate the role of Ki-67 antigen expression in predicting GNFPA recurrence.
Main Methods:
- Retrospective analysis of 35 GNFPA patients operated between 2000-2010.
- Endoscopic transsphenoidal surgery as the primary approach.
- Immunohistochemical analysis of Ki-67 labeling index (LI) and hormonal receptors.
Main Results:
- Surgical interventions included 49 procedures (44 transsphenoidal, 5 transcranial).
- Significant improvement in visual acuity (80%) and visual field defects (73.9%) post-surgery.
- Recurrence was observed in 3 patients with Ki-67 LI >3%.
Conclusions:
- While surgery improves symptoms, GNFPA recurrence is a concern.
- Ki-67 LI >3% is associated with an increased risk of recurrence in GNFPA patients.
