[Functional Pituitary Adenoma/Neuroendocrine Tumors]

Area of Science:

• Neurosurgery
• Endocrinology
• Oncology

Background:

• Therapeutic outcomes for functioning pituitary neuroendocrine tumors (PitNETs) have improved due to advancements in surgical and medical treatments.
• Surgical progress is driven by evolving endoscopic techniques, refined instruments, and ongoing technical innovations.

Purpose of the Study:

• To highlight the crucial role of surgery in achieving endocrine remission for functioning PitNETs.
• To discuss the strategic considerations for surgical resection, including endoscopic endonasal approaches.

Main Methods:

• Endoscopic endonasal surgery, a microsurgical technique, requires a wide surgical corridor while preserving nasal structures.
• Selective total resection is pursued for non-invasive tumors, emphasizing precise tumor-normal tissue interface identification and extracapsular dissection.
• Maximal safe debulking and tumor control are aims for large invasive tumors, often combined with adjuvant therapies.

Main Results:

• Tumor invasion of the cavernous sinus is a significant predictor of poor outcomes.
• Resection of the medial wall of the cavernous sinus can potentially lead to remission in select cases.
• Comprehensive therapeutic strategies integrating surgery, medical, and/or radiation therapies are essential for managing invasive tumors.

Conclusions:

• Endoscopic endonasal surgery is pivotal for achieving endocrine remission in functioning PitNETs.
• Surgical success depends on meticulous technique, especially in navigating complex anatomical structures like the cavernous sinus.
• Multimodal treatment approaches are necessary for optimizing outcomes in patients with invasive functioning pituitary neuroendocrine tumors.