Endoscopic Approaches to Giant Invasive Pituitary Adenomas—Management Stratagems

Pituitary adenomas represent 10 to 15% of all primary brain tumors. Although benign, some tumors can be aggressive. Most giant pituitary macro adenomas are non-functioning. Since these tumors do not manifest signs of endocrine hyperfunction, the clinical presentation of giant NFPA (GNFPA) is usually secondary to symptoms of mass effect such as visual disturbances, headaches, and impaired pituitary function. Endoscopic Trans-sphenoidal resection of adenomas has been the mainstay of treatment in patients with symptomatic tumors. However gross total excision has been an issue especially when it is Knosp grades 3B and 4. Many may require two-stage surgery combining trans-sphenoidal and transcranial approaches.

Often these patients need adjuvant treatment. Postoperative Radiation therapy is the primary form of postoperative adjuvant therapy. However, it has its side effects including visual dysfunction from optic neuropathy, stroke, and damage to other cranial nerves.

These benign tumors may recur after surgery and it would be very useful to understand those pathologic factors such as the proliferation markers, to predict progression, or recurrence as this knowledge could affect the use of adjuvant treatments.

In this presentation, we will discuss endoscopic approaches to this difficult tumors, discuss issues with their removal, and also discuss adjuvant therapy.

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Artikel online veröffentlicht:
07. Februar 2025