Successful treatment for giant pituitary adenomas through diverse transcranial approaches in a series of 15 consecutive patients

Abstract Object Giant pituitary adenomas (GPAs) remain a therapeutic challenge with high mortality and morbidity. We described our experience in a consecutive series of GPAs with extensive suprasellar extension. Methods A series of 15 consecutive patients with maximum dimension of more than 4 cm was...

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Veröffentlicht in:Clinical neurology and neurosurgery 2012-09, Vol.114 (7), p.885-890
Hauptverfasser: Guo, Fuyou, Song, Laijun, Bai, Jie, Zhao, Peichao, Sun, Hongwei, Liu, Xianzhi, Yang, Bo, Wang, Shukai
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container_end_page 890
container_issue 7
container_start_page 885
container_title Clinical neurology and neurosurgery
container_volume 114
creator Guo, Fuyou
Song, Laijun
Bai, Jie
Zhao, Peichao
Sun, Hongwei
Liu, Xianzhi
Yang, Bo
Wang, Shukai
description Abstract Object Giant pituitary adenomas (GPAs) remain a therapeutic challenge with high mortality and morbidity. We described our experience in a consecutive series of GPAs with extensive suprasellar extension. Methods A series of 15 consecutive patients with maximum dimension of more than 4 cm was enrolled in present study. These cases were microsurgically treated through diverse transcranial approach in our neurosurgical department from January 2006 to January 2011. Four different transcranial microsurgical approaches were selected based on tumor localization and expansion as well as neurosurgeon's experience. Results Gross total removal (GTR) was achieved in 10 of all patients (67%), subtotal removal was achieved in 5 of 15 (33%). Nine patients experienced visual improvement postoperatively compared with those of preoperative symptom (82%), no intraoperative or postoperative death was observed in present series. The most striking features of this study indicate that an experienced team can reach 67% with no mortality, no panhypopituitarism and no permanent diabetes insipidus dealing with GPAs. No recurrent tumor was found in the GPAs with GTR, adjuvant radiation therapy had been performed in 5 patients and the continuous shrinkage of the residual adenomas was achieved in 2 out of 5 with radiotherapy. Conclusions Transcranial approach was still a relatively reliable and safe management for complex GPAs with extensive suprasellar extension.
doi_str_mv 10.1016/j.clineuro.2012.01.033
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We described our experience in a consecutive series of GPAs with extensive suprasellar extension. Methods A series of 15 consecutive patients with maximum dimension of more than 4 cm was enrolled in present study. These cases were microsurgically treated through diverse transcranial approach in our neurosurgical department from January 2006 to January 2011. Four different transcranial microsurgical approaches were selected based on tumor localization and expansion as well as neurosurgeon's experience. Results Gross total removal (GTR) was achieved in 10 of all patients (67%), subtotal removal was achieved in 5 of 15 (33%). Nine patients experienced visual improvement postoperatively compared with those of preoperative symptom (82%), no intraoperative or postoperative death was observed in present series. The most striking features of this study indicate that an experienced team can reach 67% with no mortality, no panhypopituitarism and no permanent diabetes insipidus dealing with GPAs. No recurrent tumor was found in the GPAs with GTR, adjuvant radiation therapy had been performed in 5 patients and the continuous shrinkage of the residual adenomas was achieved in 2 out of 5 with radiotherapy. Conclusions Transcranial approach was still a relatively reliable and safe management for complex GPAs with extensive suprasellar extension.</description><identifier>ISSN: 0303-8467</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2012.01.033</identifier><identifier>PMID: 22326130</identifier><identifier>CODEN: CNNSBV</identifier><language>eng</language><publisher>Amsterdam: Elsevier B.V</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Clinical features ; Female ; Follow-Up Studies ; Giant pituitary adenoma ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Middle Aged ; Mortality ; Neurology ; Neurosurgery ; Neurosurgical Procedures - adverse effects ; Neurosurgical Procedures - methods ; Pituitary gland ; Pituitary Hormones - blood ; Pituitary Neoplasms - pathology ; Pituitary Neoplasms - surgery ; Postoperative Complications - epidemiology ; Radiotherapy, Adjuvant ; Sinuses ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgical apparatus &amp; instruments ; Surgical outcomes ; Transcranial approach ; Treatment Outcome ; Tumors ; Young Adult</subject><ispartof>Clinical neurology and neurosurgery, 2012-09, Vol.114 (7), p.885-890</ispartof><rights>Elsevier B.V.</rights><rights>2012 Elsevier B.V.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2012 Elsevier B.V. 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We described our experience in a consecutive series of GPAs with extensive suprasellar extension. Methods A series of 15 consecutive patients with maximum dimension of more than 4 cm was enrolled in present study. These cases were microsurgically treated through diverse transcranial approach in our neurosurgical department from January 2006 to January 2011. Four different transcranial microsurgical approaches were selected based on tumor localization and expansion as well as neurosurgeon's experience. Results Gross total removal (GTR) was achieved in 10 of all patients (67%), subtotal removal was achieved in 5 of 15 (33%). Nine patients experienced visual improvement postoperatively compared with those of preoperative symptom (82%), no intraoperative or postoperative death was observed in present series. The most striking features of this study indicate that an experienced team can reach 67% with no mortality, no panhypopituitarism and no permanent diabetes insipidus dealing with GPAs. No recurrent tumor was found in the GPAs with GTR, adjuvant radiation therapy had been performed in 5 patients and the continuous shrinkage of the residual adenomas was achieved in 2 out of 5 with radiotherapy. Conclusions Transcranial approach was still a relatively reliable and safe management for complex GPAs with extensive suprasellar extension.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Clinical features</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Giant pituitary adenoma</subject><subject>Humans</subject><subject>Immunohistochemistry</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neurology</subject><subject>Neurosurgery</subject><subject>Neurosurgical Procedures - adverse effects</subject><subject>Neurosurgical Procedures - methods</subject><subject>Pituitary gland</subject><subject>Pituitary Hormones - blood</subject><subject>Pituitary Neoplasms - pathology</subject><subject>Pituitary Neoplasms - surgery</subject><subject>Postoperative Complications - epidemiology</subject><subject>Radiotherapy, Adjuvant</subject><subject>Sinuses</subject><subject>Surgery (general aspects). 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We described our experience in a consecutive series of GPAs with extensive suprasellar extension. Methods A series of 15 consecutive patients with maximum dimension of more than 4 cm was enrolled in present study. These cases were microsurgically treated through diverse transcranial approach in our neurosurgical department from January 2006 to January 2011. Four different transcranial microsurgical approaches were selected based on tumor localization and expansion as well as neurosurgeon's experience. Results Gross total removal (GTR) was achieved in 10 of all patients (67%), subtotal removal was achieved in 5 of 15 (33%). Nine patients experienced visual improvement postoperatively compared with those of preoperative symptom (82%), no intraoperative or postoperative death was observed in present series. The most striking features of this study indicate that an experienced team can reach 67% with no mortality, no panhypopituitarism and no permanent diabetes insipidus dealing with GPAs. No recurrent tumor was found in the GPAs with GTR, adjuvant radiation therapy had been performed in 5 patients and the continuous shrinkage of the residual adenomas was achieved in 2 out of 5 with radiotherapy. Conclusions Transcranial approach was still a relatively reliable and safe management for complex GPAs with extensive suprasellar extension.</abstract><cop>Amsterdam</cop><pub>Elsevier B.V</pub><pmid>22326130</pmid><doi>10.1016/j.clineuro.2012.01.033</doi><tpages>6</tpages></addata></record>
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source MEDLINE; Access via ScienceDirect (Elsevier); ProQuest Central UK/Ireland
subjects Adult
Aged
Biological and medical sciences
Clinical features
Female
Follow-Up Studies
Giant pituitary adenoma
Humans
Immunohistochemistry
Magnetic Resonance Imaging
Male
Medical sciences
Middle Aged
Mortality
Neurology
Neurosurgery
Neurosurgical Procedures - adverse effects
Neurosurgical Procedures - methods
Pituitary gland
Pituitary Hormones - blood
Pituitary Neoplasms - pathology
Pituitary Neoplasms - surgery
Postoperative Complications - epidemiology
Radiotherapy, Adjuvant
Sinuses
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgical apparatus & instruments
Surgical outcomes
Transcranial approach
Treatment Outcome
Tumors
Young Adult
title Successful treatment for giant pituitary adenomas through diverse transcranial approaches in a series of 15 consecutive patients
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