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Robotic Radiosurgery for Persistent Postoperative Acromegaly in Patients with Cavernous Sinus-Invading Pituitary Adenomas—A Multicenter Experience
Article

Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience

1
Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France
2
Neurosurgery Unit, Department of Basic Medical Sciences, Neurosciences, Sense Organs, University “Aldo Moro”, 70124 Bari, Italy
3
Neurosurgery Unit, Humanitas Research Hospital, 20089 Milano, Italy
4
Neurosurgery Department, Parma and Reggio Emilia Hospital, University of Parma, 43126 Parma, Italy
5
Endocrinology Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France
6
Neurosurgery Department, Oxford University Hospital, Oxford OX3 9DU, UK
*
Author to whom correspondence should be addressed.
The authors contributed equally to the work.
Academic Editor: Fabio R. Faucz
Cancers 2021, 13(14), 3603; https://doi.org/10.3390/cancers13143603
Received: 2 May 2021 / Revised: 22 June 2021 / Accepted: 10 July 2021 / Published: 18 July 2021
(This article belongs to the Special Issue New Advances and Challenges in Sellar and Para-Sellar Pathology)
Giant pituitary adenomas are highly invasive tumors whose treatment is challenging. Surgery is their management mainstay. However, there is no consensus about the type of approach. Open transcranial, microscopic, and endoscopic trans-sphenoidal approaches have all been employed, alone or in combination. Extended endoscopic endonasal techniques may represent a versatile and safe one-stage approach. Our research aimed at evaluating prospectively their applicability, effectiveness, and safety in a multicenter series, to acquire further evidence toward its use in the treatment of those challenging lesions. Ninety-six patients were recruited and followed-up for 52.4 months on average. Most of them (81.2%) presented with visual deficits and >50% had various degrees of adenohypophysis insufficiency. Resection of at least 75% of initial volume was achieved in all cases, with 98.7% visual improvement, >50% endocrine deficit recovery and a permanent complication rate of 4.2%, indicating extended endoscopic endonasal approaches as a valuable treatment option.
Purpose: To evaluate factors influencing clinical and radiological outcome of extended endoscopic endonasal transtuberculum/transplanum approach (EEA-TTP) for giant pituitary adenomas (GPAs). Methods: We recruited prospectively all consecutive GPAs patients undergoing EEA-TTP between 2015 and 2019 in 5 neurosurgical centers. Preoperative clinical and radiologic features, visual and hormonal outcomes, extent of resection (EoR), complications and recurrence rates were recorded and analyzed. Results: Of 1169 patients treated for pituitary adenoma, 96 (8.2%) had GPAs. Seventy-eight (81.2%) patients had visual impairment, 12 (12.5%) had headaches, 3 (3.1%) had drowsiness due to hydrocephalus, and 53 (55.2%) had anterior pituitary insufficiency. EoR was gross or near-total in 46 (47.9%) and subtotal in 50 (52.1%) patients. Incomplete resection was associated with lateral suprasellar, intraventricular and/or cavernous sinus extension and with firm/fibrous consistence. At the last follow-up, all but one patient (77, 98.7%) with visual deficits improved. Headache improved in 8 (88.9%) and anterior pituitary function recovered in 27 (50.9%) patients. Recurrence rate was 16.7%, with 32 months mean recurrence-free survival. Conclusions: EEA-TTP is a valid option for GPAs and seems to provide better outcomes, lower rate of complications and higher EoR compared to one- or multi-stage microscopic, non-extended endoscopic transsphenoidal, and transcranial resections. View Full-Text
Keywords: giant pituitary adenomas; pituitary tumors; endoscopy; visual field; visual acuity; pituitary insufficiency; endoscopic endonasal extended approach; trans-tuberculum/transplanum approach; Pituitary Apoplexy giant pituitary adenomas; pituitary tumors; endoscopy; visual field; visual acuity; pituitary insufficiency; endoscopic endonasal extended approach; trans-tuberculum/transplanum approach; Pituitary Apoplexy
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MDPI and ACS Style

Chibbaro, S.; Signorelli, F.; Milani, D.; Cebula, H.; Scibilia, A.; Bozzi, M.T.; Messina, R.; Zaed, I.; Todeschi, J.; Ollivier, I.; Mallereau, C.H.; Dannhoff, G.; Romano, A.; Cammarota, F.; Servadei, F.; Pop, R.; Baloglu, S.; Lasio, G.B.; Luca, F.; Goichot, B.; Proust, F.; Ganau, M. Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience. Cancers 2021, 13, 3603. https://doi.org/10.3390/cancers13143603

AMA Style

Chibbaro S, Signorelli F, Milani D, Cebula H, Scibilia A, Bozzi MT, Messina R, Zaed I, Todeschi J, Ollivier I, Mallereau CH, Dannhoff G, Romano A, Cammarota F, Servadei F, Pop R, Baloglu S, Lasio GB, Luca F, Goichot B, Proust F, Ganau M. Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience. Cancers. 2021; 13(14):3603. https://doi.org/10.3390/cancers13143603

Chicago/Turabian Style

Chibbaro, Salvatore, Francesco Signorelli, Davide Milani, Helene Cebula, Antonino Scibilia, Maria T. Bozzi, Raffaella Messina, Ismail Zaed, Julien Todeschi, Irene Ollivier, Charles H. Mallereau, Guillaume Dannhoff, Antonio Romano, Francesco Cammarota, Franco Servadei, Raoul Pop, Seyyid Baloglu, Giovanni B. Lasio, Florina Luca, Bernard Goichot, Francois Proust, and Mario Ganau. 2021. "Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience" Cancers 13, no. 14: 3603. https://doi.org/10.3390/cancers13143603

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