Context: Although the majority of pituitary macroadenomas are clinically nonfunctioning, treatments as well as follow-up strategy for this condition lack evidence from randomized studies. Evidence Acquisition: We evaluated the evidence of treatment and follow-up strategies for clinically nonfunctioning adenomas. PubMed was searched for articles on nonfunctioning adenomas in November 2007, and references of selected articles were assessed for potentially relevant articles. Evidence Synthesis: All evidence for treatment and follow-up for nonfunctioning adenomas is based on observational studies. The most effective treatment is transsphenoidal surgery, indicated in patients with visual field defects. A wait-and-see approach may be considered in nonfunctioning macroadenomas not reaching to the optic chiasm. Some of these tumors (∼10%) will show spontaneous regression, whereas in approximately 50% there will be progression within 5 yr observation. Postoperative radiotherapy should not be applied to all patient...

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Treatment and follow-up of clinically nonfunctioning pituitary macroadenomas.

Object Nonfunctioning pituitary adenomas (NFPAs) are benign tumors of the pituitary gland that typically cause visual and/or hormonal dysfunction. Surgery is the treatment of choice, but patients remain at risk for tumor recurrence for several years afterwards. The authors evaluate the early results of surgery and the long-term risk of tumor recurrence in patients with NFPAs. Methods Between 1990 and 2005, 491 previously untreated patients with NFPA underwent surgery at the Universita Vita-Salute. Determinations of recurrence or growth of the residual tumor tissue during the follow-up period were based on neuroradiological criteria. Results Residual tumor after surgery was detected in 173 patients (36.4%). Multivariate analysis showed that invasion of the cavernous sinus, maximum tumor diameter, and absence of tumor apoplexy were associated with an unfavorable surgical outcome. At least 2 sets of follow-up neuroimaging studies were obtained in 436 patients (median follow-up 53 months). Tumors recurred in ...

Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence.

during the follow-up period. Ninety-seven patients could be assessed for tumor regrowth or tumor recurrence after a mean follow-up period of 6.0 3.7 yr. In nine patients there was evidence for tumor regrowth, and in one patient tumor recurrence was observed. The mean time to tumor growth/recurrence after initial therapy was 6.9 (range 3–12) yr. Follow-up duration was found to be an independent predictor for tumor regrowth. Conclusion: Transsphenoidal surgery without postoperative radiotherapyisaneffectiveandsafetreatmentstrategyforNFMA,without evidence for tumor regrowth in 90% of all patients, at least for the duration of follow-up presented in this study. Additional studies are required to exclude higher regrowth and recurrence rates during prolongation of the duration of follow-up.(J Clin Endocrinol Metab 91: 1796–1801, 2006)

Observation alone after transsphenoidal surgery for nonfunctioning pituitary macroadenoma.

Object Craniopharyngioma accounts for 2%–5% of all primary intracranial neoplasms. The optimal management of craniopharyngioma remains controversial. The authors evaluated the early results of surgery and the longterm risk of tumor recurrence in a large series of patients undergoing resection of craniopharyngiomas. Methods Between 1990 and 2008, 112 consecutive patients (57 male and 55 female patients with a mean [± SEM] age of 33.3 ± 1.8 years) underwent resection of craniopharyngiomas at the authors' hospital. Recurrence or growth of residual tumor tissue during follow-up was assessed using MR imaging. Results There were 3 perioperative deaths (2.7%). Severe adverse events were more frequent in patients who underwent operations via the transcranial route (37%) than the transsphenoidal approach (5.6%; p < 0.001). Magnetic resonance imaging showed radical resection of the tumor in 78 (71.6%) of the remaining 109 patients. Previous surgery and maximum tumor diameter were associated with persistence of dise...

Neurosurgical treatment of craniopharyngioma in adults and children: early and long-term results in a large case series

Object Giant pituitary adenomas (> 4 cm in maximum diameter) represent a significant surgical challenge Endoscopic endonasal surgery (EES) has recently been introduced as a treatment option for these tumors The authors present the results of EES for giant adenomas and analyze the advantages and limitations of this technique Methods The authors retrospectively reviewed the medical files and imaging studies of 54 patients with giant pituitary adenomas who underwent EES and studied the factors affecting surgical outcome Results Preoperative visual impairment was present in 45 patients (83%) and partial or complete pituitary deficiency in 28 cases (52%), and 7 patients (13%) presented with apoplexy Near-total resection (> 90%) was achieved in 36 patients (667%) Vision was improved or normalized in 36 cases (80%) and worsened in 2 cases due to apoplexy of residual tumor Significant factors that limited the degree of resection were a multilobular configuration of the adenoma (p = 0002) and extension to

Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations

¶Introduction. The aim of this study was to define the impact of surgery on pituitary function in a large consecutive series of patients harbouring non-functioning pituitary adenomas.

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R. Fahlbusch

Papers

Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas – a study on 721 patients

Clinical Article Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas - a study on 721 patients