gms | German Medical Science

Objective: The aim of our retrospective study was the analysis of clinical symptoms, surgical intervention, postoperative course and long-term follow-up of patients treated between 1992 and 2012 in our department.

Method: We retrospectively reviewed the charts, patient's records, MRI-, CT- and X-ray scans, surgical reports and clinical notes of adult patients with CP and collected all data in a newly founded access 2010 data bank. For statistical analysis IBM SPSS statistics (V19), chi-quadrat test and fisher test were applied.

Results: The median age of our group (21 male, 26 female) was 42 years (range 18-86 years). 32 patients (68%) presented with assorted patterns of field deficits, scotomas and decreasing visual acuity. Only 16 patients (34%) suffered from headaches. The most common endocrinopathy was gonadal failure (16 patients, 34%). In 40 of 47 patients (85%) only, we were able to reconstruct the planned surgical approach and the planned extent of resection (GTR/ STR). The right pterional approach was used in 19 patients (47.5%), the left pterional in 9 patients (22.5%), the transnasal-transsphenoidal in 9 patients (22.5%), the subfrontal right in 2 patients (5%) and the bifrontal in 1 patient (2.5%). 39 (97.5%) of the 40 patients were considered for total resection, which was achieved in 31 patients (77.5%) as confirmed by postoperative neuroimaging.

Concerning the whole group of 47 patients, in a median time of 17 months (range 4.6–146) 12 patients (25.5%) suffered from the first recurrent tumor growth. Four patients (8.5%) developed the second recurrent tumor growth within a median interval of 23.5 months (2.7–49). Only 1 patient (2.1%) underwent postoperative radiation therapy, because of second recurrence and subtotal resection (STR).

An injury of pituitary stalk occurred in 5 patients (10.6%) resulting in severe endocrinological complications, 3 patients (6.4%) experienced a deterioration of the visual acuity, 3 patients (6.4%) postoperative hemorrhages and 7 patients (15%) cognitive deficits. Three patients (6.4%) died within the first 5 months because of severe hypothalamo-hypophyseal disturbances. The Kaplan-Meier 5 year survival in our group is 93%.

Conclusions: CP is a serious disease with a high percentage of complications. Total resection is often not possible, however should be the goal of surgery, while preserving all functional structures. Long-term follow-up is necessary, since tumor recurrence might develop even after MRI-confirmed complete resection.