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Outcomes of Surgically Treated Giant Pituitary Tumours

Published online by Cambridge University Press:  02 December 2014

Michael D. Cusimano ,
Peter Kan ,
Farshad Nassiri ,
Jennifer Anderson ,
Jeannette Goguen ,
Irene Vanek ,
Harley S. Smyth ,
Ronald Fenton ,
Paul J. Muller  and
Kalman Kovacs
Michael D. Cusimano*
Affiliation:
Division of Neurosurgery, Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Peter Kan
Affiliation:
Division of Neurosurgery, Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Farshad Nassiri
Affiliation:
Division of Neurosurgery, Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Jennifer Anderson
Affiliation:
Department of Surgery, Department of Otorhinolaryngology, Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Jeannette Goguen
Affiliation:
Division of Endocrinology, Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Irene Vanek
Affiliation:
Department of Medicine, Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Harley S. Smyth
Affiliation:
Division of Neurosurgery, Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Ronald Fenton
Affiliation:
Department of Surgery, Department of Otorhinolaryngology, Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Paul J. Muller
Affiliation:
Division of Neurosurgery, Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
Kalman Kovacs
Affiliation:
Division of Pathology, Department of Laboratory Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
*
Division of Neurosurgery, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. Email: injuryprevention@smh.ca
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Abstract

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Objective:

To evaluate the outcomes of patients with giant pituitary tumours (GPTs) who underwent a purely binasal endoscopic transsphenoidal surgery (BETS) and compare their outcomes with those achieved through craniotomy and microscopic transsphenoidal surgery (MTS).

Methods:

Seventy-two consecutive patients with GPTs (greater than 10 cm3 in volume) who were treated surgically with BETS, craniotomy, or MTS from October 1994 to July 2009 were reviewed for clinical outcomes, degree of tumor resection, recurrence rates, and surgical complications.

Results:

The BETS group had significantly better mean reduction of tumor volume (91%) than the craniotomy (63%, p = 0.001), and the MTS (63%, p = 0.010) groups. Gross total resection rates were also higher for BETS patients than for craniotomy patients (p = 0.010). Improvements in vision and headaches were noted in 96% and 100% of patients in the BETS group, respectively; these rates were similar to those in the craniotomy and MTS groups. Of the four patients with hormone-secreting tumours in the BETS group, three remained in remission. The median length-of-stay (four days) for the BETS group was shorter (p = 0.010), and surgical complications were less frequent (p = 0.037) and less severe compared to the craniotomy group. There were no differences in the recurrence rates: 79% percent of patients in the BETS group, 69% in the craniotomy group, and 79% in the MTS group were recurrence free at last follow-up (p = 0.829).

Conclusions:

Treatment of GPT with BETS offers excellent oncologic and clinical outcomes and can frequently obviate the need for craniotomy in these patients.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 4 , July 2012 , pp. 446 - 457
Copyright
Copyright © The Canadian Journal of Neurological 2012

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