Microsurgical strategy of invasive pituitary adenomas

Abstract

Objective To analyze the efficacy of different surgical approach for invasive pituitary adenoma and to raise the rational microsurgical strategy. Methods We retrospectively analyzed the clinical data of 441 patients with invasive pituitary adenomas at the Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from July 2012 to June 2015. The clinical manifestation, imaging data, surgical methods, microsurgical skills and prognosis were reviewed. Suprasellar invasive was identified in 310 patients, parasellar was in 293 patients and the sellar floor was in 187 patient. 318 patients underwent transsphenoidal surgery, while 123 patients were treated by craniotomy. In the cases of patients treated by craniotomy, the number of patients undergoing the subfrontal approach, the frontal lateral approach, the frontal temporal approach, the anterior interhemispheric approach and the callosal interforniceal approach was respectively 31, 50, 22, 11 and 9. Univariate analysis and Logistic regression analysis were used to evaluate the influencing factors of surgical approach for invasive pituitary adenoma. Results The suprasellar (P 15 cm3 (P<0.001) were the main factors to choose craniotomy, while the sellar floor (P<0.001) is the main factor to use transsphenoidal approach. The options of subfrontal approach, frontal lateral approach or frontal temporal approach were related to the parasellar (P<0.001) and width of the tumor (P=0.001). The height of the tumor (P<0.001) was associated with the selections of the subfrontal approach, the anterior interhemispheric approach or the callosal interforniceal approach. Conclusions The options of the surgical approach of invasive pituitary adenomas should be on the basis of preoperative patient status and imaging findings. Transsphenoidal surgery has unique advantages for excising the tumor which pushes the internal wall of the cavernous sinus - false tumor invasion . The frontal lateral approach takes a advantage of the subfrontal approach and the frontal temporal approach to remove the tumor in the cavernous sinus. The options of the anterior interhemispheric approach to remove tumor involving suprasellar space avoid the disconnection syndrome after the operation though the callosal interforniceal approach, and the gross-total resection rate is higher. Key words: Pituitary adenoma; Neurosurgical procedures; Surgical approach; Prognosis