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Identifier 000384117
Title Χειρουργική αντιμετώπιση αδενωμάτων της υπόφυσης : έλεγχος χειρουργικού αποτελέσματος και συσχετισμός της λειτουργίας του αδένα προεγχειρητικά και μετεγχειρητικά με μαγνητική τομογραφία
Alternative Title Surgical treatment of pituitary adenomas:
Author Λαμπρόπουλος, Κωνσταντίνος
Thesis advisor Σαμώνης, Γεώργιος
Reviewer Μαργιωρής, Α.
Καραντάνας, Α.
Ζώρας, Ο.
Θερμού, Κ.
Βάκης, Α.
Κοφτερίδης, Δ.
Abstract OBJECTIVE: Despite advances in the pharmacological management of pituitary tumors, surgery remains the treatment of choice for the majority of adenomas. Surgical results, that are judged nowadays by strict endocrine criteria and sophisticated imaging, have justified transsphenoidal surgery as the most common and successful treatment of pituitary adenomas. The aim of the present study was the evaluation and assessment of factors that influence the outcome of microsurgical transsphenoidal surgery in a consecutive series of patients harbouring adenomas, treated using a standardized operative technique, and also the evaluation of the efficacy and safety of the procedure. The pre- and postoperative magnetic resonance imaging data were compared, and the postoperative ones were correlated to the success of the operation, in terms of restoration of pituitary function. In parallel, aim was the prospective record of complications and/or infections associated with the procedure, the treatment and outcome of these, in addition to the comparison with what is mentioned in the literature. PATIENTS AND METHODS: Between March 2004 and June 2011, a total of 184 patients underwent transsphenoidal microsurgery for pituitary adenoma, by the same surgical team, at the Diagnostic and Therapeutic Center of Athens «Hygeia». In all, preoperative endocrinological, neuroradiological, and neuro-opthalmological evaluation was performed. Extent of tumor resection and disease remission were defined according to recently established radiological and hormonal consensus criteria. Mean duration of follow-up was 3.6 ± 2 years. RESULTS: Nonfunctioning adenomas: According to the first postoperative neuroimaging study, gross total resection was demonstrable in 61 (62.9%) of the 97 patients and tumor remnants were seen in 36 (37.1%). Patients with favourable surgical outcome had statistically significant smaller adenomas, compared to those with an unfavourable one (median value of maximum tumor diameter 24 mm vs 31 mm, respectively; p &λτ 0.001). Multivariate logistic regression analysis showed that tumor invasion of the cavernous sinus (p ΄&λτ 0.001), relatively large diameter (΄&γε 25 mm) (p΄&λτ 0.05), and reoperation (p ΄&λτ 0.05), were associated with unfavourable surgical outcome, whereas suprasellar extension, sphenoid sinus invasion and pituitary apoplexy had no statistically significant independent association with the outcome. Functioning adenomas: According to the first postoperative neuroimaging study, gross total resection was demonstrable in 63 (72.4%) of the 87 patients and the rate was 88.9% for micro- and 65% for macroadenomas. Patients with favourable surgical outcome had statistically significant smaller adenomas, compared to those with an unfavourable one (median value of maximum tumor diameter 12 mm vs 25 mm, respectively; p ΄&λτ 0.001). Multivariate logistic regression analysis showed that tumor invasion of the cavernous sinus (p΄&λτ 0.001), as well as relatively large diameter (΄&γε 25 mm) (p ΄&λτ0.001), were associated with unfavourable surgical outcome, whereas suprasellar extension was not. Patients with endocrinological remission had statistically significant smaller adenomas, compared to those without remission (11 mm vs 15 mm, respectively; p΄&λτ 0.05). Multivariate analysis has shown that remission was feasible for adenomas with smaller diameter (΄&λε 20 mm) (p΄&λτ 0.05) and reoperation was the only negative predictor for endocrinological remission (p ΄&λτ 0.05). CONCLUSIONS: 1. Magnetic resonance imaging provides satisfactory depiction of the pre- and postoperative features of pituitary adenomas. Postoperative remnants of even only few millimetres can be accurately visualized. 2. The gross total resection, as it is confirmed by the imaging study, is statistically significant correlated to the endocrinological remission of patients with functioning adenomas. 3. The surgical outcome is statistically significant influenced by the size of the adenoma, the invasion of the cavernous sinus and the reoperation. 4. In patients with postoperative worsening of pituitary function, magnetic resonance imaging depicts anatomic distortions (pituitary stalk intersection, and/or low magnetic signal of the posterior lobe). 5. Microsurgical transsphenoidal surgery can be considered the first-choice therapy in all patients with pituitary adenoma, except for prolactinomas responsive to dopamine agonists.
Language Greek
Subject Ptuitary adenoma
Surgical outcome
Transsphenoidal microsurgery
Αδένωμα υπόφυσης
Μικροχειρουργική διασφηνοειδική επέμβαση
Χειρουργικό αποτέλεσμα
Issue date 2014-07-24
Collection   Faculty/Department--School of Medicine--Department of Medicine--Doctoral theses
  Type of Work--Doctoral theses
Permanent Link https://elocus.lib.uoc.gr//dlib/9/9/7/metadata-dlib-1399970540-422138-22149.tkl Bookmark and Share
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