Background: Giant and large pituitary adenomas (PA) constitute a specific subset of PAs, with gross total resection (GTR) rates frequently not exceeding 50%. Both an anatomical inaccessibility and an inadequate tumor visualization are thought to play a role. This study analyzes risk factors for postoperative residuals after endoscopic transsphenoidal pituitary surgery for large and giant pituitary adenomas.
Methods: A retrospective analysis of patients with giant and large PA operated between 2015 and 2018 was performed.
Results: Forty patients (13 females, 27 males) were included in the analysis (30 large and 10 giant PAs). The mean MRI follow-up time was 5.9 ± 6.54 months. Overall, GTR was achieved in 29 patients (72.5%), subtotal resection in 9 (22.5%), and the inconclusive result was in 2 (5%). Unexpected residuals represented 7 (77.7%) of all 9 residual tumors. The most frequent intraoperative factor associated with unexpected residual tumors was improper identification of residual tumor due to obstruction of view in 2 (28.5%) cases and inability to distinguish normal tissue from tumor in the other two (28.5%). Sub-analysis based on tumor size revealed that with large PAs, GTR was achieved in 25 (83.3%), STR in 4 (13.3%), and inconclusive in 1 (3.3%) patient. In patients with giant PAs, GTR was achieved in 4 (40%), STR in 5 (50%), and inconclusive in 1 (10%). Analysis of preoperative factors showed a significant association of residual tumors with larger suprasellar AP distance (p = 0.041), retrosellar extension (p = 0.007), and higher Zurich Score (p = 0.029).
Conclusion: Large and giant PAs are challenging lesions with high subtotal resection rates. Suprasellar AP distance, retrosellar extension, and higher Zurich Score seem to be significant predictors of degree of resection in these tumors. Improving the intraoperative ability to distinguish tumor from a normal tissue might further decrease the number of unexpected residuals.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s00701-020-04497-1 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Photosymbiosis shaped animal genome architecture and gene evolution as revealed in giant clams.
Commun Biol
January 2025
Department of Ecology and Evolutionary Biology, University of Colorado Boulder, Boulder, CO, USA.
Symbioses are major drivers of organismal diversification and phenotypic innovation. However, how long-term symbioses shape whole genome evolution in metazoans is still underexplored. Here, we use a giant clam (Tridacna maxima) genome to demonstrate how symbiosis has left complex signatures in an animal's genome.
View Article and Find Full Text PDFThe importance of color and body size for reproductive decision making by males and females of the giant river prawn, Macrobrachium rosenbergii (de Man, 1879) (Decapoda, Caridea, Palaemonidae).
Behav Processes
January 2025
Laboratory of Sensory Ecology, Department of Physiology & Behavior, Biosciences Center, Federal University of Rio Grande do Norte, Natal-RN, Brazil. Electronic address:
The selection and expression of conspicuous colorations in animals is often related to anti-predation strategies and sociosexual communication. The giant river prawn, Macrobrachium rosenbergii (de Man, 1879) is a species with three male morphotypes that vary in claws' coloration and the size of the animals. It has been suggested that male reproductive quality might be associated to their coloration, but evidence is still conflicting.
View Article and Find Full Text PDFPurpose: Proliferative vitreoretinopathy (PVR) is the leading cause of surgical failure following rhegmatogenous retinal detachment (RRD). In this study, we aimed to explore ocular and systemic risk factors for PVR due to RRD in a large patient database.
Methods: Patients who have a diagnosis of RRD and PVR, and who have been seen in the last seven years prior to analysis (January 2015-February 2023) were identified in the Vestrum Health database.
Circulating PD-1hi CXCR5- and CXCR5+ CD4 T cells are elevated in patients with newly diagnosed Giant Cell Arteritis and predict relapse.
Rheumatology (Oxford)
January 2025
Department of Rheumatology, Hospital Universitario La Paz-IdiPaz, Madrid, Spain.
Objectives: Giant cell arteritis (GCA) is a large/medium-vessel granulomatous vasculitis, and the PD-1/PD-L1 coinhibitory pathway seems to be implicated in its pathogenesis. CD4 T cells expressing high PD-1 levels, CD4+CXCR5-PD-1hi peripheral helper (Tph) and CD4+CXCR5+PD-1hi follicular helper T cells (Tfh), are key mediators of autoimmunity. Their frequencies are elevated in the peripheral blood of subjects with several autoimmune conditions but have not been investigated in GCA.
View Article and Find Full Text PDFIntroduction: Adrenal myelolipomas are uncommon benign adrenal tumors, which mostly occur unilaterally. We describe a rare case of giant bilateral adrenal myelolipoma mistaken for retroperitoneal liposarcoma.
Case Presentation: A 49-year-old man developed fever, left flank pain, and a large mass in his left abdomen.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!