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A new comprehensive grading for giant pituitary adenomas: SLAP grading
Dhaval Shukla1, Subhas Konar1, Akshay Kulkarni1
1Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
British Journal of Neurosurgery
|April 1, 2022
Summary
A new grading system for giant pituitary adenomas (GPAs) called SLAP effectively predicts resection extent. Higher SLAP scores correlate with increased likelihood of subtotal resection in these complex tumors.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Giant pituitary adenomas (GPAs) pose significant surgical challenges due to their extensive multicompartmental growth.
- Accurate preoperative assessment of tumor extension is crucial for surgical planning and predicting outcomes.
Purpose of the Study:
- To introduce and validate a novel grading system, the Superior, Lateral, Anterior, and Posterior (SLAP) grading system, for GPAs.
- To correlate the SLAP grading system with the extent of tumor resection achieved in patients with GPAs.
Main Methods:
- Retrospective review of 103 patients with GPAs (≥4 cm).
- Tumor extension assessed using the SLAP system (maximum score of 10).
- Subtotal resection (STR) defined as >10% residual tumor volume; association with SLAP score analyzed.
Main Results:
- All 103 GPAs exhibited suprasellar extension; 97.3% had lateral extension.
- Higher SLAP scores (≥5) were significantly associated with subtotal resection (odds ratio 5.02, p=0.004).
- 46.6% of patients had a total SLAP score of 5 or more, and 62.2% underwent STR.
Conclusions:
- The SLAP grading system provides a comprehensive and easily applicable method for evaluating GPA extension.
- SLAP grading aids in predicting surgical resectability and planning for giant pituitary adenomas.
