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[Controversies in the management of operated pituitary macroadenomas]
Background And Purpose:
Complete resection of a pituitary adenoma is feasible in almost 50 to 70% of cases. Dealing with the remnant is still controversial. Three positions can be discussed: second stage operation, radiation therapy, clinical and radiological follow-up.
Methods:
Among 108 pituitary macroadenomas operated on during the last 10 years, 54 patients (50%) with partially removed tumors were studied. Three cases best illustrating the evolution of these remnants are reported.
Results:
Late MRI performed 4 to 6 months postoperatively is more valuable than early MRI in the evaluation of these remnants, which can remain stable for a long period of time without any adjuvant treatment.
Conclusion:
MRI should be performed 4 to 6 months postoperatively. Rather than performing radiation therapy systematically for asymptomatic patients, these patients should be followed up at regular intervals and treated only in case of regrowth of the tumor.