Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지

Preliminary Surgical Results of Open Sella Method with Intentionally Staged Transsphenoidal Approach for Patients with Giant Pituitary Adenomas

  • Kim, Young-Zoon (Department of Neurosurgery, College of Medicine, Dong-A University) ;
  • Song, Yeung-Jin (Department of Neurosurgery, College of Medicine, Dong-A University) ;
  • Kim, Hyung-Dong (Department of Neurosurgery, College of Medicine, Dong-A University)
  • Published : 2005.01.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: This study is designed to evaluate the clinical outcome, the safety and the effectiveness of the open sella methods(OSM) with intentionally staged transsphenoidal approach(TSA) for giant pituitary adenomas(GPA). Methods: Eight patients with GPA were managed by the OSM with intentionally staged TSA. There were 5 nonfunctioning adenomas, 2 prolactin-secreting adenomas, and 1 growth hormone-secreting adenoma. Among them, 6 patients underwent two times of TSA, one patient underwent three times of TSA, and the other patient underwent two times of TSA followed by radiation therapy. The mean time interval between staged operations was 3.9 months except for one case. Results: Seven out of the eight patients with GPA treated with the OSM with intentionally staged TSA showed that the tumors were completely removed on magnetic resonance imaging and that they were free from headache and visual problem suffered previously. Only one patient experienced severe complications including panhypo-pituitarism, cerebrospinal fluid rhinorrhea and permanent diabetes insipidus. Conclusion: With the surgical treatment for 8 cases of GPA, which extended to the suprasellar and parasellar area, we suggest that the OSM with intentionally staged TSA is a safe and effective method in management for GPA.

Keywords

References

  1. Alleyne CH Jr, Barrow DL, Oyesiku NM : Combined transsphenoidal and pterional craniotomy approach to giant pituitary tumors. Surg Neurol : 380-390, 2002 https://doi.org/10.1016/S0090-3019(02)00705-X
  2. Fahlbusch R, Buchfelder M : Transsphenoidal surgery of parasellar pituitary adenomas. Acta Neurochir(Wien) 92 : 93-99, 1988 https://doi.org/10.1007/BF01401978
  3. Fahlbusch R, Buchfelder M : Current management of invasive pituitary adenoma. Contemporary Neurosurgery Vol 11, 1989
  4. Fisher BJ, Gaspar LE, Noone B : Giant pituitary adenomas : role of radiotherapy. Int J Radiat Oncol Biol Phys 25 : 677-681, 1993 https://doi.org/10.1016/0360-3016(93)90015-N
  5. Fraioli B, Esposito V, Santoro A, Lannetti G, Giuffre R, Cantore G : Transmaxillosphenoidal approach to tumors invading the medial compartment of the cavernous sinus. J Neurosurg 82 : 63-69, 1995 https://doi.org/10.3171/jns.1995.82.1.0063
  6. Goel A, Nadkarni T : Surgical management of giant pituitary tumors : a review of 30 cases. Acta Neurochir(Wien) 138 : 1042-1049, 1996 https://doi.org/10.1007/BF01412306
  7. Grote E : Characteristics of giant pituitary adenomas. Acta Neurochir(Wien) 60 : 141-153, 1982 https://doi.org/10.1007/BF01406303
  8. Guidetti B, Fraioli B, Cantore GP : Results of surgical management of 319 pituitary adenomas. Acta neurochir(Wien) 85 : 117-124, 1987 https://doi.org/10.1007/BF01456107
  9. Guiot G, Deromoe P : Surgical problems of pituitary adenomas. Adv Tech Stand Neurosurg 3 : 3-33, 1976
  10. Hardy J : Transshenoidal approach to the pituitary gland, in Wilkins RH, Rengachary SS(eds) : Neurosurgery, ed 2, New York : Mc Graw- Hill Book Co., 1996, Vol 1, p1376
  11. Hardy J, Vezina JL : Transsphenoidal neurosurgery of intracranial neoplasm. Adv Neurol 15 : 261-273, 1976
  12. Hattori K, Kuwayama A : Current technical aspect in transsphenoidal pituitary adenomectomy. Nippon Rinsho 51 : 2742-2747, 1993
  13. Kaufman B, Kaufman BA, Arafah BM, Roessmann U, Selman WR : Large pituitary gland adenomas evaluated with magnetic resonance imaging. Neurosurgery 21 : 540-546, 1987 https://doi.org/10.1097/00006123-198710000-00017
  14. King WA, Becker DP : The transsphenoidal approach to pituitary macroadenomas with cavernous sinus extensions, in Al Mefty O, Origitano TC, Harkey HL(eds) : Controversies in neurosurgery, New York : GTV, Stuttgart, 1996, pp15-20
  15. Kovacs K, Horvath E : Pathology of pituitary tumour. Endocrinol Metab Clin North Am 16 : 529-551, 1987
  16. Laws ER : Comment. Neurosurgery 14 : 488, 1984
  17. Loyo M, Kleriga E, Mateos H, de Leo R, Delgado A : Combined supra-infrasellar approach for large pituitary tumors. Neurosurgery 14 : 485-488, 1984 https://doi.org/10.1097/00006123-198404000-00017
  18. Mohr G, Hardy J, Comtois R, Beauregard H : Surgical management of giant pituitary adenomas. Can J Neurol Sci 17 : 62-66, 1990 https://doi.org/10.1017/S0317167100030055
  19. Nakane T, Kuwayama A, Watanabe M, Kageyama N : Transsphenoidal approach to pituitary adenomas with suprasellar extension. Surg Neurol 16 : 225-229, 1981 https://doi.org/10.1016/0090-3019(81)90012-4
  20. Pia HW, Grote E, Hildebrandt G : Giant pituitary adenomas. Neurosurg Rev 8 : 207-220, 1985 https://doi.org/10.1007/BF01815445
  21. Sethi DS, Pillay PK : Endoscopic management of lesions of the sella turcica. J Laryngol Otol 109 : 956-962, 1995
  22. Snow RB, Johnson CE, Morgello S, Lavyne MH, Patterson RH Jr : Is magnetic resonance imaging useful in guiding the operative approach to large pituitary tumor ? Neurosurgery 26 : 801-803, 1990 https://doi.org/10.1097/00006123-199005000-00011
  23. Spaziante R, de Divitiis E : Forced subarachnoid air in transsphenoidal excision of pituitary tumors (pumping technique). J Neurosurg 71 : 864-867, 1989 https://doi.org/10.3171/jns.1989.71.6.0864
  24. Srivastava VK, Narayanaswamy KS, Rao TV : Giant pituitary adenoma. Surg Neurol 20 : 379-382, 1983 https://doi.org/10.1016/0090-3019(83)90006-X
  25. Symon L, Jakubowski J, Kendall B : Surgical treatment of giant pituitary adenomas. J Neurol Neurosurg Psychiatry 42 : 973-982, 1979 https://doi.org/10.1136/jnnp.42.11.973
  26. Tamiya T, Ono Y, Date I, Kawauchi M, Matsumoto K, Ohmoto T : Extradural temporopolar approach for giant pituitary adenomas invading the cavernous sinus and parasellar regions. No Shinkei Geka 26 : 803-811, 1998
  27. Van Lindert EJ, Grotenhuis JA, Meijer E : Results of follow-up after removal of non-funtioning pituitary adenomas by transcranial surgery. Br J Neurosurg 5 : 129-133, 1991 https://doi.org/10.3109/02688699108998458
  28. Wilson CB : Role of surgery in the management of pituitary tumor( review). Neurosurg Clin N am 1 : 139-159, 1990
  29. Yasargil MG : Transcranial surgery for large pituitary adenomas, in Curcic M, Valavanis A, Yasargil DCH(eds) : Microneurosurgery of CNS Tumors, New York : GTV, Stuttgart, 1996, pp200-204
  30. Zhang X, Fei Z, Zhang J, Fu L, Zhang Z , Liu W, et al : Management of nonfunctioning pituitary adenomas with suprasellar extensions by transsphenoidal microsurgery. Surg Neurol 52 : 380-385, 1999 https://doi.org/10.1016/S0090-3019(99)00120-2