Features of pituitary metastases surgery
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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