Surgical management of giant pituitary neuroendocrine tumors: Meta-analysis and consensus statement on behalf of the EANS skull base section

Brain and Spine

Henry W.S. Schroeder¹  Ari G. Chacko²  Dimitrios Paraskevopoulos³  Micheal Bruneau⁴  Paul A. Gardner⁵  Emmanuel Jouanneau⁵  Moncef Berhouma⁵  Paolo Cappabianca⁶  Sebastien Froelich⁷  Giulia Cossu⁸  Mahmoud Messerer⁸  Ethan Harel⁸  Lorenzo Giammattei⁸  Daniele Starnoni⁸  Jan F. Cornelius⁹  Torstein R. Meling^1,10  Idoya Zazpe^1,11  Roy T. Daniel^1,12  Luigi M. Cavallo^1,12  Henry Dufour^1,13  Diego Mazzatenta^1,14  Romain Manet^1,15 

[1] Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, UK;Department of Neurological Science, Christian Medical College, Vellore, Tamilnadu, India;Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and the Royal London Hospital, London, UK;Department of Neurosurgery, Erasme Hospital, Brussels, Belgium;Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Lyon, France;Department of Neurosurgery, Hopital de la Timone, Marseille, France;Department of Neurosurgery, Lariboisière Hospital, Paris, France;Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, Switzerland;Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany;Department of Neurosurgery, University Hospital of Geneva, Switzerland;Department of Neurosurgery, University Hospital of Greifswald, Germany;Department of Neurosurgery, University Hospital of Naples Federico II, Italy;Department of Neurosurgery, University Hospital of Pittsburgh, PA, USA;IRCCS Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy;Servicio de Neurocirugía, Complejo Hospitalario de Navarra, Pamplona, Spain;

关键词: Giant pituitary adenoma;    Giant PitNET;    Surgery;    Endoscopy;    Transcranial approach;    Apoplexy;   

DOI  :  

来源: DOAJ

【 摘 要 】

Introduction: The optimal surgical treatment for giant pituitary neuroendocrine tumors(GPitNETs) is debated. Research question: The aim of this paper is to optimize the surgical management of these patients and to provide a consensus statement on behalf of the EANS Skull Base Section. Material and methods: We constituted a task force belonging to the EANS skull base committee to define some principles for the management of GPitNETs. A systematic review was performed according to PRISMA guidelines to perform a meta-analysis on surgical series of GPitNETs. Weighted summary rates were obtained for the pooled extent of resection and according to the surgical technique. These data were discussed to obtain recommendations after evaluation of the selected articles and discussion among the experts. Results: 20articles were included in our meta-analysis, for a total of 1263 patients. The endoscopic endonasal technique was used in 40.3% of cases, the microscopic endonasal approach in 34% of cases, transcranial approaches in 18.7% and combined approaches in 7% of cases. No difference in terms of gross total resection (GTR) rate was observed among the different techniques. Pooled GTR rate was 36.6%, while a near total resection (NTR) was possible in 45.2% of cases. Cavernous sinus invasion was associated with a lower GTR rate (OR: 0.061). After surgery, 35% of patients had endocrinological improvement and 75.6% had visual improvement. Recurrent tumors were reported in 10% of cases Discussion and conclusion: After formal discussion in the working group, we recommend the treatment of G-PitNETs tumors with a more complex and multilobular structure in tertiary care centers. The endoscopic endonasal approach is the first option of treatment and extended approaches should be planned according to extension, morphology and consistency of the lesion. Transcranial approaches play a role in selected cases, with a multicompartmental morphology, subarachnoid invasion and extension lateral to the internal carotid artery and in the management of residual tumor apoplexy.

【 授权许可】

Unknown