Article
A single center series of 16 pituitary metastases and their surgical management
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Authors
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Till Burkhardt
- Neurochirurgie/Universtätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Marvin Henze
- Neurochirurgie , Hamburg, Deutschland
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Luis Kluth
- Urologie, Hamburg, Deutschland
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Manfred Westphal
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
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Nils Ole Schmidt
- Hamburg, Deutschland
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Jörg Flitsch
- University Hospital Hamburg-Eppendorf, Neurosurgery, Hamburg, Deutschland
| Published: | June 9, 2017 |
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Outline
Text
Objective: Pituitary Metastases are rare, therefore this entity is not subject to standardized guidelines. There is debate about typical initial symptoms that may lead to the correct diagnosis and information about the clinical course is sparse.
Methods: Retrospective analysis of patients with pituitary metastases, surgically treated via a transsphenoidal procedure between 2006 through 2014. Primary disease, clinical and surgical course as well as adjuvant radiotherapy and follow-up data are presented.
Results: 14 patients (8 female, 6 male). Mean age 61.5 years. Most patients became symptomatic with visual symptoms -visual deterioration and diplopia (n=13)- and anterior lobe insufficiency (n=8). Diabetes insipidus was seen in 3 patients. All underwent transsphenoidal surgery, 4 patients had to undergo surgery for residual tumor or recurrence, two via a transcranial route. Breast cancer was the most common entity (n=6) , followed by prostate cancer (n=3), non-small cell lung cancer (n=2) and melanoma, thyroid cancer and renal cancer in one case each. Postoperative MRI showed gross total resection in 4 cases and residual disease in 8 cases, 2 patients files were incomplete regarding MRI-results. All patients underwent adjuvant radiotherapy. Survival after the initial diagnosis of cancer was 36 months and 16 months after diagnosis of pituitary metastases.
Conclusion: Transsphenoidal surgery is a safe method to resect pituitary metastases, the extent of resection does not influence survival time. Diabetes insipidus may not be the most common initial symptom of pituitary metastases and lack thereof should not lead to making a wrong diagnosis and delaying appropriate therapy.
