Giant Non-Functioning Pituitary Adenomas: Treatment Considerations
Giant pituitary adenomas are a subgroup of pituitary adenomas defined by a diameter greater than 4 cm, and they account for 5–14% of adenomas in surgical series. Because of their growth patterns and locations, often involving critical neurovascular structures, they represent a true surgical challeng...
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| Format: | Article |
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MDPI AG
2022-09-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/12/9/1256 |
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| author | Domenico Solari Luigi Maria Cavallo Chiara Graziadio Sergio Corvino Ilaria Bove Felice Esposito Paolo Cappabianca |
| author_facet | Domenico Solari Luigi Maria Cavallo Chiara Graziadio Sergio Corvino Ilaria Bove Felice Esposito Paolo Cappabianca |
| author_sort | Domenico Solari |
| collection | DOAJ |
| description | Giant pituitary adenomas are a subgroup of pituitary adenomas defined by a diameter greater than 4 cm, and they account for 5–14% of adenomas in surgical series. Because of their growth patterns and locations, often involving critical neurovascular structures, they represent a true surgical challenge, and gross total resection is difficult to achieve. There is no consensus on the optimal surgical strategy for giant pituitary adenomas, and, often, integrated multi-staged treatment strategies have been considered. Transcranial or transsphenoidal approaches, alone or combined, according to tumor and patient features are the two main routes. Each of these strategies has pros and cons. The conventional transcranial approach has for a long time been considered the first choice for the removal of giant pituitary adenomas. Currently, with endoscopic techniques, it is also possible to remove lesions that involve the intradural compartment and the adjacent neurovascular structures with the use of extended approaches. Our policy for the management of these lesions is to adopt the endoscopic endonasal approach as the first choice unless the tumor presents significant intracranial extension that results in it being outside the visibility and maneuverability of the endoscopic endonasal route. In these latter cases, we agree that the transcranial approach is more appropriate. However, accurate preoperative evaluation and refined treatment plans for each patient are mandatory to define a proper strategy in order to achieve the most effective long-term result. |
| first_indexed | 2024-03-10T00:33:35Z |
| format | Article |
| id | doaj.art-9b567ccd2e1d42e99d2a77158661e9db |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-10T00:33:35Z |
| publishDate | 2022-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-9b567ccd2e1d42e99d2a77158661e9db2023-11-23T15:21:52ZengMDPI AGBrain Sciences2076-34252022-09-01129125610.3390/brainsci12091256Giant Non-Functioning Pituitary Adenomas: Treatment ConsiderationsDomenico Solari0Luigi Maria Cavallo1Chiara Graziadio2Sergio Corvino3Ilaria Bove4Felice Esposito5Paolo Cappabianca6Division of Neurosurgery, Università degli Studi di Napoli “Federico II”, Via Pansini 5, 80131 Naples, ItalyDivision of Neurosurgery, Università degli Studi di Napoli “Federico II”, Via Pansini 5, 80131 Naples, ItalyDivision of Endocrinology, Università degli Studi di Napoli “Federico II”, Via Pansini 5, 80131 Naples, ItalyDivision of Neurosurgery, Università degli Studi di Napoli “Federico II”, Via Pansini 5, 80131 Naples, ItalyDivision of Neurosurgery, Università degli Studi di Napoli “Federico II”, Via Pansini 5, 80131 Naples, ItalyDivision of Neurosurgery, Università degli Studi di Napoli “Federico II”, Via Pansini 5, 80131 Naples, ItalyDivision of Neurosurgery, Università degli Studi di Napoli “Federico II”, Via Pansini 5, 80131 Naples, ItalyGiant pituitary adenomas are a subgroup of pituitary adenomas defined by a diameter greater than 4 cm, and they account for 5–14% of adenomas in surgical series. Because of their growth patterns and locations, often involving critical neurovascular structures, they represent a true surgical challenge, and gross total resection is difficult to achieve. There is no consensus on the optimal surgical strategy for giant pituitary adenomas, and, often, integrated multi-staged treatment strategies have been considered. Transcranial or transsphenoidal approaches, alone or combined, according to tumor and patient features are the two main routes. Each of these strategies has pros and cons. The conventional transcranial approach has for a long time been considered the first choice for the removal of giant pituitary adenomas. Currently, with endoscopic techniques, it is also possible to remove lesions that involve the intradural compartment and the adjacent neurovascular structures with the use of extended approaches. Our policy for the management of these lesions is to adopt the endoscopic endonasal approach as the first choice unless the tumor presents significant intracranial extension that results in it being outside the visibility and maneuverability of the endoscopic endonasal route. In these latter cases, we agree that the transcranial approach is more appropriate. However, accurate preoperative evaluation and refined treatment plans for each patient are mandatory to define a proper strategy in order to achieve the most effective long-term result.https://www.mdpi.com/2076-3425/12/9/1256pituitary adenomasendoscopic endonasal surgeryskull base surgerypituitary/hypothalamusendocrinologyneurosurgery |
| spellingShingle | Domenico Solari Luigi Maria Cavallo Chiara Graziadio Sergio Corvino Ilaria Bove Felice Esposito Paolo Cappabianca Giant Non-Functioning Pituitary Adenomas: Treatment Considerations Brain Sciences pituitary adenomas endoscopic endonasal surgery skull base surgery pituitary/hypothalamus endocrinology neurosurgery |
| title | Giant Non-Functioning Pituitary Adenomas: Treatment Considerations |
| title_full | Giant Non-Functioning Pituitary Adenomas: Treatment Considerations |
| title_fullStr | Giant Non-Functioning Pituitary Adenomas: Treatment Considerations |
| title_full_unstemmed | Giant Non-Functioning Pituitary Adenomas: Treatment Considerations |
| title_short | Giant Non-Functioning Pituitary Adenomas: Treatment Considerations |
| title_sort | giant non functioning pituitary adenomas treatment considerations |
| topic | pituitary adenomas endoscopic endonasal surgery skull base surgery pituitary/hypothalamus endocrinology neurosurgery |
| url | https://www.mdpi.com/2076-3425/12/9/1256 |
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