Efficacy of transcranial surgery combined with transsphenoidal endoscopic surgery for patients with giant invasive pituitary adenoma
SUN Xiao
FENG Si-zhe
LIANG Guo-biao
HAN Song
SUN Xiao-yu
BAI Yang
LI Xin-ning
WANG Ge-yu
SUN Ying-wei
Abstract：Objective To investigate the efficacy of transcranial surgery(TCS)combined with transsphenoidal endoscopic surgery(TSES)for patients with giant(>4 cm)invasive pituitary adenoma.Methods The clinical data of 18 patients with giant invasive pituitary adenoma,who underwent TCS combined with TSES from September 2017 to March 2023,were retrospectively analyzed.The postoperative tumor resection rate,hormone remission,intracranial infection,operative area bleeding,and other complications were observed.Results Total tumor resection was achieved in 14 patients(77.8%),and subtotal in 4(22.2%).The average operation time was(5.2±1.4)hours.Postoperative endocrine reexamination showed that of 11 patients with increased prolactin before surgery,8 patients returned to normal and 3 did not change significantly after surgery.Additionally,one patient with increased adrenocorticotropic hormone before surgery returned to normal after the procedure.Adrenal insufficiency occurred in 2 patients(11.1%),temporary diabetes insipidus in 2(11.1%),acute epidural hematoma at a remote site in 1,and cerebrospinal fluid leakage in 1.There were no intracranial infection or operative area bleeding.Follow-up ranged from 3 months to 24 months with an average of(10.1±9.1)months.One patient recurred after subtotal resection(tumor diameter approximately 1 cm),which was subsequently treated using gamma knife therapy without any significant growth thereafter.The headache remission rate was 78.6%(11/14),and the improvement rate for vision and visual field reached up to 85.7%(12/14).Conclusions TCS combined with TSES is a safe,effective,and feasible approach for treating giant invasive pituitary adenomas.When a giant invasive pituitary adenoma is difficult to be resected from a single approach after adequate preoperative evaluation,combined surgery can be selected to achieve one-stage safe tumor resection.
Keywords：Giant invasive pituitary adenomasTranscranial surgery(TCS)Transsphenoidal endoscopic surgery(EETS)Efficacy
Publication Date：2023-09-25
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：4( 545-548 )