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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Endoscopic endonasal resection of large and giant pituitary adenomas: outcome and predictors of extent of resection

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  • Boris Krischek - Klinik für Allgemeine Neurochirurgie, Universitätsklinikum Köln, Köln, Deutschland; Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
  • Kyle Juraschka - Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
  • Bruno Godoy - Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
  • Allan Vescan - Department of Otolaryngology – Head and Neck Surgery, University of Toronto, Toronto, Canada
  • Fred Gentili - Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
  • Gelareh Zadeh - Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMO.04.04

doi: 10.3205/13dgnc032, urn:nbn:de:0183-13dgnc0320

Published: May 21, 2013

© 2013 Krischek et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: While the use of endoscopic approaches has become increasingly accepted in the resection of pituitary adenomas, limited evidence exists regarding the success of this technique for patients with large and giant pituitary adenomas. This study presents the outcomes of a large cohort of patients with large and giant pituitary adenomas who underwent endoscopic endonasal transsphenoidal surgery (EETS) and focuses on identifying factors that can predict extent of resection, and hence aid in developing guidelines and indications for the use of EETS versus open craniotomy approaches to large and giant pituitary adenomas.

Method: We reviewed 487 patients who underwent EETS resection of sellar masses. From this group, seventy-three consecutive patients with large and giant pituitary adenomas (defined as maximum diameter ≥3 cm and tumour volume ≥10 cm3) who underwent EETS between January 2006 and May 2012 were included in the study.

Results: The mean pre-operative tumour diameter in this series was 4.1 cm and volume was 18.43 cm3. The average resection rate was 82.9%, corresponding with a mean residual volume of 3.15 cm3. Gross total resection was achieved for 16 patients (24.2%), near total in 11 (16.7%), subtotal in 24 (36.4%), and partial in 15 (22.7%). 73.0% of patients experienced improvement in visual acuity, while 23.8% were unchanged. Visual fields were improved in 61.8% and unchanged in 38.2%. Overall, 27 patients (37.0%) experienced a total of 32 complications. The most common complications were sinusitis (13.7%) and CSF leak (9.6%). Statistically significant predictors of extent of resection included highest Knosp Grade (p<0.001), pre-operative tumour volume (p=0.025), pre-operative maximum tumour diameter (p=0.002), hemorrhagic component (p=0.049), posterior extension (p=0.001), and sphenoid sinus invasion (p=0.005).

Conclusions: EETS is an effective treatment method for patients with giant pituitary adenomas, which results in high (> 80%) rates of resection and improvement in visual function. It is not associated with high rates of major complications and is safe when performed by experienced surgeons. The preoperative Knosp Grade, tumour volume, tumour diameter, hemorrhagic components on MRI, posterior extension, and sphenoid sinus invasion may allow a prediction of extent of resection.