Objectives: The natural history of Non-Functioning Pituitary Adenoma (NFPA) remains poorly understood and clinical management of this kind of lesions is often matter of debate. Currently transsphenoidal surgery is considered the treatment option for both efficacy and safety. The invasion of the cavernous sinus (CSI) by tumor increases the difficulty in surgical planning as this aspect can not always be identified with certainty on preoperative imaging. In several studies we have seen that the rate of complete resection is reduced abruptly to zero when considering adenomas with parasellar extension. Despite the effectiveness of radiation therapy is well recognized in the control of the disease after partial removal, the unpleasant long-term toxicity is considered the main reason to prefer to wait and see follow-up of the patients. Methods: 205 consecutive non-functioning pituitary adenomas were treated by a purely endoscopic endonasal transsphenoidal (TSS) technique from 1999 to 2010. In the present study we review 56 cases of NFPA with cavernous sinus invasion. The Knosp classification was used to describe cavernous sinus involvement as evidenced by MRI, which was confirmed intraoperatively. Extent of resection was evaluated on postoperative contrast-enhanced MRI, as well as the surgical and visual outcomes. Endocrinological remission was defined according to the most recent consensus criteria. Results: Clinical presentation was dominated by headache, visual disturbance and hypopituitarism. Endoscopic endonasal transsphenoidal surgery was performed using direct paraseptal, transethmoidal or transethmoidalpterigoidal approach. The surgical procedure was well tolerated by all patients. At discharge, visual disturbance was improved in 30 (81%) patients who had complained visual impairment preoperatively. In this series was achieved normalization or improvement of previous hypopituitarism in 55% of cases. A gross total resection was achieved in 30.3% of all patients. The recurrence-free survival in this series was 87.5%, in agreement with several studies reporting remission rate of 79.9 to 90% of non-functioning adenomas treated surgically. No major complications occurred. Conclusion: The surgical approach using endoscopic endonasal transsphenoidal technique is a safe and effective procedure for the management of NFPA, able to solve the mass effect, preserving or restoring visual function and to obtain an adequate long-term tumor control. However, close screening of pituitary function and appropriate neuroradiological follow-up should be performed after surgery for detection of tumor recurrence or regrowth.
Non-Functioning Pituitary Adenomas with Cavernous Sinus Invasion: our experience
Ferreli F;
2012-01-01
Abstract
Objectives: The natural history of Non-Functioning Pituitary Adenoma (NFPA) remains poorly understood and clinical management of this kind of lesions is often matter of debate. Currently transsphenoidal surgery is considered the treatment option for both efficacy and safety. The invasion of the cavernous sinus (CSI) by tumor increases the difficulty in surgical planning as this aspect can not always be identified with certainty on preoperative imaging. In several studies we have seen that the rate of complete resection is reduced abruptly to zero when considering adenomas with parasellar extension. Despite the effectiveness of radiation therapy is well recognized in the control of the disease after partial removal, the unpleasant long-term toxicity is considered the main reason to prefer to wait and see follow-up of the patients. Methods: 205 consecutive non-functioning pituitary adenomas were treated by a purely endoscopic endonasal transsphenoidal (TSS) technique from 1999 to 2010. In the present study we review 56 cases of NFPA with cavernous sinus invasion. The Knosp classification was used to describe cavernous sinus involvement as evidenced by MRI, which was confirmed intraoperatively. Extent of resection was evaluated on postoperative contrast-enhanced MRI, as well as the surgical and visual outcomes. Endocrinological remission was defined according to the most recent consensus criteria. Results: Clinical presentation was dominated by headache, visual disturbance and hypopituitarism. Endoscopic endonasal transsphenoidal surgery was performed using direct paraseptal, transethmoidal or transethmoidalpterigoidal approach. The surgical procedure was well tolerated by all patients. At discharge, visual disturbance was improved in 30 (81%) patients who had complained visual impairment preoperatively. In this series was achieved normalization or improvement of previous hypopituitarism in 55% of cases. A gross total resection was achieved in 30.3% of all patients. The recurrence-free survival in this series was 87.5%, in agreement with several studies reporting remission rate of 79.9 to 90% of non-functioning adenomas treated surgically. No major complications occurred. Conclusion: The surgical approach using endoscopic endonasal transsphenoidal technique is a safe and effective procedure for the management of NFPA, able to solve the mass effect, preserving or restoring visual function and to obtain an adequate long-term tumor control. However, close screening of pituitary function and appropriate neuroradiological follow-up should be performed after surgery for detection of tumor recurrence or regrowth.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
