Clinical study of endoscopic treatment of a sellar pituitary adenomas with sellar diaphragm defect

Zhuoru Jin,Xinyu Wu,Yibao Wang

doi:10.1186/s12883-020-01690-8

Zhuoru Jin, Xinyu Wu + Show 1 more

Open Access

https://doi.org/10.1186/s12883-020-01690-8

Copy DOI

Journal: BMC Neurology	Publication Date: Apr 11, 2020
Citations: 6	License type: open-access

Affiliation: China Medical University

Abstract

BackgroundInvasive growth of pituitary macroadenomas to the suprasellar region occurs commonly. Pituitary adenomas show varying growth patterns when the sellar diaphragm is absent, and they are often confused with other common tumors in the sellar region. This article explores the clinical features of suprasellar pituitary adenomas with defects of the sellar diaphragm (SPADSD) and evaluates the efficacy of the endoscopic endonasal approach (EEA) for treatment of such tumors.MethodsWe performed a detailed examination of records from 19 patients collected prior to surgery. After relevant diseases were excluded, the tumor properties were evaluated according to imaging characteristics. Diagnoses were verified using EEA surgery. The concept of SPADSD was put forward. Postoperative recovery was followed to determine whether EEA is suitable for the treatment of such tumors.ResultsIn the 19 patients with SPADSD, we found that the tumors were less stressed on the pituitary, and tumors in the suprasellar region often had irregular shapes. During surgery, we took extended supra-saddle approaches and confirmed that unrestricted growth of the tumor was caused by defects in the diaphragm of the sella turcica to the suprasellar region. Recovery was good after surgery, confirming the efficacy of EEA for treatment of these tumors.ConclusionSPADSD has different clinical features from those of other pituitary tumors and requires careful screening prior to surgery. Endoscopic surgery is the preferred procedure for this type of tumor.

Highlights

Invasive growth of pituitary macroadenomas to the suprasellar region occurs commonly
The Hardy grading standard describes the degree of suprasellar extension of the tumor: Grade 0, the tumor remains in the saddle; Grade A, the tumor expands to the suprasellar cistern; Grade B, Jin et al BMC Neurology (2020) 20:129 recessus opticus block; Grade C, the third ventricle is significantly displaced; Grades D are defined as the extent of the tumor above 20 mm on the sphenoid bone [6]
All 19 patients underwent surgery using endoscopic endonasal approach (EEA). We confirmed that these patients suffered from congenital loss of the diaphragm sella turcica (Fig. 1a, b), causing the tumor to invade from the saddle to the suprasellar region

Summary

Introduction

Invasive growth of pituitary macroadenomas to the suprasellar region occurs commonly. According to the Hardy classification, tumors above the suprasellar cistern are referred to as suprasellar pituitary adenomas. In actual clinical work, a very small number of patients with saddle pituitary tumors have a congenital diaphragm sella turcica defects or serious defects in the diaphragm sella turcica. These conditions make the tumors originating in the sella have no pressure effect, and they grow irregularly to the suprasellar region. The tumor can invade the optic chiasma forward and squeeze the third ventricle floor upward We call this a suprasellar pituitary adenoma with defect of sellar diaphragm (SPADSD). Nonfunctional pituitary tumors are diagnosed when the volume grows to a large extent and causes symptoms such as decreased vision [8, 9]

Methods

Results

Discussion

Conclusion