ABSTRACT
The aim of this investigation was to evaluate the clinical significance of the various optional surgical approaches for giant and irregular pituitary adenomas and to summarize the optimal surgical protocols for the adenomas in terms of different growth morphologies. Fifty-four cases with giant and irregular pituitary adenomas were treated by studying their clinical features and image examinations, designing the specific surgical protocols, and choosing the optimal approaches according to the various growth morphologies. Neuro-endoscope and neuronavigation-assisted techniques were applied intraoperatively. Postoperative MRI and endocrine function were re-examined routinely to judge the therapeutic efficacy of various single approaches, combined approaches and staged operations. Application of the six protocols resulted in total removal of the tumours in 18 cases, subtotal removal in 28 cases, partial removal in five cases and three deaths. The most appropriate surgical approaches, which were adopted after comprehensive analyses of the morphological characteristics presented in image examinations, those involving anatomical spaces and the clinical symptoms, can achieve the improved therapeutic results and reduce injuries to the vital anatomic structures. The tumour removal rate can be increased with the help of neuro-endoscope, neuronavigation techniques and intraoperative MRI.
Subject(s)
Adenoma/surgery , Microsurgery/methods , Neuroendoscopy/methods , Pituitary Neoplasms/surgery , Adenoma/drug therapy , Adenoma/pathology , Adult , Aged , Female , Hormone Replacement Therapy/methods , Humans , Hypopituitarism/drug therapy , Hypopituitarism/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Pituitary Neoplasms/drug therapy , Pituitary Neoplasms/pathology , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To evaluate the overall effect of transsphenoidal microsurgery for pituitary adenomas in recent 5 years and to discuss the surgical technique, application of new technology and postoperative follow-up results.</p><p><b>METHODS</b>The clinical presentation, image characteristics, endocrinal findings, pathological types, tumor removal percentage, postoperative complication and follow-up of 1 462 patients with pituitary adenomas who underwent the transsphenoidal microsurgery from 1997 to 2002 were analysed retrospectively.</p><p><b>RESULTS</b>Total rate of tumor removal for the patients achieved 97.0% in the patients with Hardy I adenomas, 95.2% with Hardy II, 90.5% with Hardy III, and 47.4% with Hardy IV respectively. A significant postoperative improvement both in clinical symptoms and endocrinal parameters was achieved. The tumor recurrence rate was 0.3%.</p><p><b>CONCLUSIONS</b>With the improvement of microsurgical technique and application of novel technology, the indication of transsphenoidal microsurgery for pituitary adenomas was increasingly extended. Endoscope and(/or) neuronavigation-assisted microsurgery via transsphenoidal approach should be of the first choice for the treatment of pituitary adenomas. The routine postoperative radiotherapy is not required for patients with total tumor removal.</p>
