Outcomes of Aggressive Surgical Resection in Growth Hormone–Secreting Pituitary Adenomas with Cavernous Sinus Invasion

Hun Ho Park, Eui Hyun Kim, Cheol Ryong Ku, Eunjig Lee, Sun Ho Kim

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Cavernous sinus (CS) invasion is an unfavorable factor hindering the remission of growth hormone (GH)-secreting pituitary adenomas. Little data exist on aggressive surgical resection, however. We investigated the role of CS exploration for GH-secreting pituitary adenomas with CS invasion. Methods: We classified 132 patients with GH-secreting pituitary adenomas invading CS into 4 groups. The patients underwent surgery using a microsurgical transsphenoidal approach (TSA) with endoscopic assistance. Adenomas with CS invasion confined to the medial compartment of the internal carotid artery (ICA) were classified as type A (without radiologic evidence) or type B (with radiologic evidence). Adenomas with ICA encasement were classified according to the surgical approach as type C (standard TSA) or type D (far-lateral TSA). Surgical and endocrinologic outcomes were compared across groups. Results: For type A, B, C, and D tumors, the rates of gross total resection were 100%, 73.6%, 14.7%, and 0%, respectively, and the rates of endocrinologic remission by surgery alone were 100%, 62.3%, 26.5%, and 0%, respectively. There was no endocrinologic remission by surgery alone for type D tumors; nevertheless, compared with type C tumors, type D tumors showed marked reductions in the postoperative nadir of GH at 1 week, 6 months, and 1 year and of insulin-like growth factor I at 1 year. Conclusions: For tumors with CS invasion confined to the medial compartment of the ICA, total resection should be attempted by direct visualization of the entire medial wall of the CS. Even for tumors with ICA encasement, aggressive tumor resection by far-lateral TSA can increase the chance of remission with the help of adjuvant treatment.

Original languageEnglish
Pages (from-to)e280-e289
JournalWorld Neurosurgery
Volume117
DOIs
Publication statusPublished - 2018 Sep 1

Fingerprint

Cavernous Sinus
Pituitary Neoplasms
Growth Hormone-Secreting Pituitary Adenoma
Internal Carotid Artery
Growth
Neoplasms
Adenoma
Insulin-Like Growth Factor I
Growth Hormone

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Park, Hun Ho ; Kim, Eui Hyun ; Ku, Cheol Ryong ; Lee, Eunjig ; Kim, Sun Ho. / Outcomes of Aggressive Surgical Resection in Growth Hormone–Secreting Pituitary Adenomas with Cavernous Sinus Invasion. In: World Neurosurgery. 2018 ; Vol. 117. pp. e280-e289.
@article{00f310a4b075458f9bb5b66176792e86,
title = "Outcomes of Aggressive Surgical Resection in Growth Hormone–Secreting Pituitary Adenomas with Cavernous Sinus Invasion",
abstract = "Background: Cavernous sinus (CS) invasion is an unfavorable factor hindering the remission of growth hormone (GH)-secreting pituitary adenomas. Little data exist on aggressive surgical resection, however. We investigated the role of CS exploration for GH-secreting pituitary adenomas with CS invasion. Methods: We classified 132 patients with GH-secreting pituitary adenomas invading CS into 4 groups. The patients underwent surgery using a microsurgical transsphenoidal approach (TSA) with endoscopic assistance. Adenomas with CS invasion confined to the medial compartment of the internal carotid artery (ICA) were classified as type A (without radiologic evidence) or type B (with radiologic evidence). Adenomas with ICA encasement were classified according to the surgical approach as type C (standard TSA) or type D (far-lateral TSA). Surgical and endocrinologic outcomes were compared across groups. Results: For type A, B, C, and D tumors, the rates of gross total resection were 100{\%}, 73.6{\%}, 14.7{\%}, and 0{\%}, respectively, and the rates of endocrinologic remission by surgery alone were 100{\%}, 62.3{\%}, 26.5{\%}, and 0{\%}, respectively. There was no endocrinologic remission by surgery alone for type D tumors; nevertheless, compared with type C tumors, type D tumors showed marked reductions in the postoperative nadir of GH at 1 week, 6 months, and 1 year and of insulin-like growth factor I at 1 year. Conclusions: For tumors with CS invasion confined to the medial compartment of the ICA, total resection should be attempted by direct visualization of the entire medial wall of the CS. Even for tumors with ICA encasement, aggressive tumor resection by far-lateral TSA can increase the chance of remission with the help of adjuvant treatment.",
author = "Park, {Hun Ho} and Kim, {Eui Hyun} and Ku, {Cheol Ryong} and Eunjig Lee and Kim, {Sun Ho}",
year = "2018",
month = "9",
day = "1",
doi = "10.1016/j.wneu.2018.06.012",
language = "English",
volume = "117",
pages = "e280--e289",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

Outcomes of Aggressive Surgical Resection in Growth Hormone–Secreting Pituitary Adenomas with Cavernous Sinus Invasion. / Park, Hun Ho; Kim, Eui Hyun; Ku, Cheol Ryong; Lee, Eunjig; Kim, Sun Ho.

In: World Neurosurgery, Vol. 117, 01.09.2018, p. e280-e289.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of Aggressive Surgical Resection in Growth Hormone–Secreting Pituitary Adenomas with Cavernous Sinus Invasion

AU - Park, Hun Ho

AU - Kim, Eui Hyun

AU - Ku, Cheol Ryong

AU - Lee, Eunjig

AU - Kim, Sun Ho

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Cavernous sinus (CS) invasion is an unfavorable factor hindering the remission of growth hormone (GH)-secreting pituitary adenomas. Little data exist on aggressive surgical resection, however. We investigated the role of CS exploration for GH-secreting pituitary adenomas with CS invasion. Methods: We classified 132 patients with GH-secreting pituitary adenomas invading CS into 4 groups. The patients underwent surgery using a microsurgical transsphenoidal approach (TSA) with endoscopic assistance. Adenomas with CS invasion confined to the medial compartment of the internal carotid artery (ICA) were classified as type A (without radiologic evidence) or type B (with radiologic evidence). Adenomas with ICA encasement were classified according to the surgical approach as type C (standard TSA) or type D (far-lateral TSA). Surgical and endocrinologic outcomes were compared across groups. Results: For type A, B, C, and D tumors, the rates of gross total resection were 100%, 73.6%, 14.7%, and 0%, respectively, and the rates of endocrinologic remission by surgery alone were 100%, 62.3%, 26.5%, and 0%, respectively. There was no endocrinologic remission by surgery alone for type D tumors; nevertheless, compared with type C tumors, type D tumors showed marked reductions in the postoperative nadir of GH at 1 week, 6 months, and 1 year and of insulin-like growth factor I at 1 year. Conclusions: For tumors with CS invasion confined to the medial compartment of the ICA, total resection should be attempted by direct visualization of the entire medial wall of the CS. Even for tumors with ICA encasement, aggressive tumor resection by far-lateral TSA can increase the chance of remission with the help of adjuvant treatment.

AB - Background: Cavernous sinus (CS) invasion is an unfavorable factor hindering the remission of growth hormone (GH)-secreting pituitary adenomas. Little data exist on aggressive surgical resection, however. We investigated the role of CS exploration for GH-secreting pituitary adenomas with CS invasion. Methods: We classified 132 patients with GH-secreting pituitary adenomas invading CS into 4 groups. The patients underwent surgery using a microsurgical transsphenoidal approach (TSA) with endoscopic assistance. Adenomas with CS invasion confined to the medial compartment of the internal carotid artery (ICA) were classified as type A (without radiologic evidence) or type B (with radiologic evidence). Adenomas with ICA encasement were classified according to the surgical approach as type C (standard TSA) or type D (far-lateral TSA). Surgical and endocrinologic outcomes were compared across groups. Results: For type A, B, C, and D tumors, the rates of gross total resection were 100%, 73.6%, 14.7%, and 0%, respectively, and the rates of endocrinologic remission by surgery alone were 100%, 62.3%, 26.5%, and 0%, respectively. There was no endocrinologic remission by surgery alone for type D tumors; nevertheless, compared with type C tumors, type D tumors showed marked reductions in the postoperative nadir of GH at 1 week, 6 months, and 1 year and of insulin-like growth factor I at 1 year. Conclusions: For tumors with CS invasion confined to the medial compartment of the ICA, total resection should be attempted by direct visualization of the entire medial wall of the CS. Even for tumors with ICA encasement, aggressive tumor resection by far-lateral TSA can increase the chance of remission with the help of adjuvant treatment.

UR - http://www.scopus.com/inward/record.url?scp=85049519839&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85049519839&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2018.06.012

DO - 10.1016/j.wneu.2018.06.012

M3 - Article

C2 - 29906579

AN - SCOPUS:85049519839

VL - 117

SP - e280-e289

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -