Features of pituitary metastases surgery
Abstract
Objective – to improve the results of surgical treatment of patients with metastatic lesion of the pituitary gland.
Materials and methods. The results of treatment of 35 patients operated on metastases of pituitary gland in the SI Romodanov Neurosurgery Institute NAMS of Ukraine at the period till 2005 to 2015 were analyzed. The diagnosis of «pituitary metastasis» is histologically confirmed in all patients. At the time of treatment in the institution in 23 patients there was one or another stage of cancer. The most frequent primary tumor was lung cancer (34.3 %), breast cancer (22.9 %), kidney (8.6 %), rectum, prostate, blood (all 5.7 %). In 27 (77.2 %) patients, transsphenoidal approach was performed, and 8 (22.8 %) were transcranial.
Results. Removing the pituitary metastasis of varying degrees of radicality was occurred in 30 (85.8 %) patients, the intracerebral tumor and the pituitary metastasis – in 3 (8.6 %). Diagnostic biopsy was performed in 2 (5.6 %) patients. Total removal of pituitary metastasis occurred in 7 (20.0 %) patients, subtotal – in 17 (48.6 %), partial – in 9 (25.7 %). The most strong predictors of total volume removal are insignificant bleeding and density of metastatic defeat, absence of spreading to the cavernous sinus. Positive dynamics of quality of life of patients after surgical treatment with metastases in the pituitary gland was associated with regression of visual disturbances, local pain syndrome, to a lesser degree with regression of oculomotor disorders.
Conclusions. The main indications for surgical intervention regarding the pituitary metastasis are the symptomatic course of the disease, the need to verify histological diagnosis in the absence of an oncological anamnesis or verification of the primary focus of the tumor. Nearest results of surgical treatment of patients with metastases in the pituitary gland demonstrated the expediency of weighted selection of patients with metastatic lesion of the pituitary gland and improvement of patients' condition by eliminating or reducing neurological symptoms.
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References
Kim YH, Lee B, Lee KJ, Cho JH. A case of pituitary metastasis from breast cancer that presented as left visual disturbance. J. Korean Neurosurg Soc. 2012;51:94-97. doi: 10.3340/jkns.2012.51.2.94.
Altay T, Krisht KM, Couldwell WT. Sellar and parasellar metastatic tumors. Int. J. Surg. Oncol. 2012:2012 Article ID. 647256. doi: 10.1155/2012/647256.
Branch CL Jr, Laws ER Jr. Metastatic tumors of the sella turcica masquerading as primary pituitary tumors. J. Clin. Endocrinol. Metab. 1987;65:469-74.
Spinelli GP, Lo Russo GL, Miele E et al. Breast cancer metastatic to the pituitary gland: a case report. World J. Surg. Oncol. 2012 ;10:137.
Chiang MF, Brock M, Patt S. Pituitary metastases. Neurochirurgia (Stuttg). 1990;33:127-31.
Feiz-Erfan I, Rao G, White W, McCutcheon I. Efficacy of trans-septal trans-sphenoidal surgery in correcting visual symptoms caused by hematogenous me- tastases to the sella and pituitary gland. Skull Base. 2008;18:77-84. doi:10.1055/s-2007-991105.
Fassett DR, Couldwell WT. Metastases to the pituitary gland. Neurosurg. Focus. 2014;16:1-4.
Ito I, Ishida T, Hashimoto T et al. Hypopituitarism due to pituitary metastasis of lung cancer: case of a 21-year-old man. Intern. Med. 2001;40:414-17. doi:10.2169/ internalmedicine.
Eksi MS, Hasanov T, Yilmaz B et al. Isolated metastasis of breast cancer to the pituitary gland. Neurol. India. 2014;62:70-1. doi: 10.4103/0028-3886.128322.
He W, Chen F, Dalm B, Kirby PA, Greenlee JDW. Metastatic involvement of the pituitary gland: a systematic review with pooled individual patient data analysis. Pituitary. 2015;18:159-68. doi: 10.1007/s11102-014-0552-2.
Morita A, Meyer FB, Laws ERJ. Symptomatic pituitary metastases. J. Neurosurg. 1998;89:69-73.
Zoli M, Mazzatenta D, Faustini-Fustini M, Pasquini E, Frank G Pituitary metastases: role of surgery. World Neurosurg. 2013;79:327-30.
Gilard V, Alexandra C, Proust F et al. Pituitary metastasis: is there still a place for neurosurgical treatment? J. Neurooncol. 2015;126(2):219-24.
Burkhardt T, Henze M, Kluth LA et al. Surgical management of pituitary metastases. Pituitary. 2016;19:11-8.
Teears RJ, Silverman EM. Clinicopathologic review of 88 cases of carcinoma metastatic to the putuitary gland. Cancer. 1975;36:216-20.
Komninos J, Vlassopoulou V, Protopapa D et al. Tumors metastatic to the pituitary gland: case report and literature review. J. Clin. Endocrinol. Metab. 2004;89:574-80.
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