The Outcome of Supergiant Pituitary Tumors Following Endonasal versus Transcranial Approaches

Objective: Pituitary tumors larger than 55 mm are highly challenging to manage due to the high risk associated with surgical intervention. The question of whether to perform endonasal or transcranial surgery is still not straightforward. This is a study evaluating the outcome of patients presenting with supergiant pituitary tumors.

Methods: Patients undergoing surgery for pituitary tumors exceeding 55 mm largest diameter, with no significant extension lateral to ICA bifurcation, were reviewed from a prospective database. Elective surgical interventions for tumors were considered distinct if spaced at least 12 months from the previous surgery. The all-cause perioperative mortality within 1 month of surgical intervention and median survival were evaluated.

Results: There were a total of 24 patients (14 males and 10 females), with ages ranging 23 to 70 (median 50) years, having a median follow-up of 40 months. These underwent 26 distinct elective surgical procedures (17 endonasal and 9 transcranial). Among 17 endonasal procedures, the initial 5 were microscopic while the latter 12 were endoscopic. 2 patients had transcranial surgery 12 months after endonasal surgery. 1 patient underwent transcranial surgery immediately after the endonasal microscopic approach and so was excluded from comparative analysis. The perioperative mortality was 8.3% after endonasal endoscopy, 22.2% after transcranial, and 50% after endonasal microscopic surgery. The median survival was 13 months after endonasal endoscopy, in contrast to 4 months following transcranial surgery. The smaller numbers of patients could not manifest any statistical significance.

Conclusion: Among supergiant pituitary tumors, endonasal endoscopy may be the initial preferred option due to the trend of lower perioperative mortality and longer median survival.

Publikationsverlauf

Artikel online veröffentlicht:
15. Februar 2022