Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence

Marco Losa, Pietro Mortini, Raffaella Barzaghi, Paolo Ribotto, Maria Rosa Terreni, Stefania Bianchi Marzoli, Sandra Pieralli, Massimo Giovanelli

Research output: Contribution to journalArticlepeer-review

Abstract

Object. Nonfunctioning pituitary adenomas (NFPAs) are benign tumors of the pituitary gland that typically cause visual and/or hormonal dysfunction. Surgery is the treatment of choice, but patients remain at risk for tumor recurrence for several years afterwards. The authors evaluate the early results of surgery and the long-term risk of tumor recurrence in patients with NFPAs. Methods. Between 1990 and 2005, 491 previously untreated patients with NFPA underwent surgery at the Università Vita-Salute. Determinations of recurrence or growth of the residual tumor tissue during the follow-up period were based on neuroradiological criteria. Results. Residual tumor after surgery was detected in 173 patients (36.4%). Multivariate analysis showed that invasion of the cavernous sinus, maximum tumor diameter, and absence of tumor apoplexy were associated with an unfavorable surgical outcome. At least 2 sets of follow-up neuroimaging studies were obtained in 436 patients (median follow-up 53 months). Tumors recurred in 83 patients (19.0%). When tumor removal appeared complete, younger age at surgery was associated with a risk of tumor recurrence. In patients with incomplete tumor removal, adjunctive postoperative radiotherapy had a marked protective effect against growth of residual tumor. Conclusions. Complete surgical removal of NFPAs can be safely achieved in >50% of cases. Visual symptoms and, less frequently, pituitary function may improve after surgery. However, tumor can recur in patients after apparently complete surgical removal. In patients with incomplete tumor removal, radiation therapy is the most effective adjuvant therapy for preventing residual tumor growth.

Original languageEnglish
Pages (from-to)525-532
Number of pages8
JournalJournal of Neurosurgery
Volume108
Issue number3
DOIs
Publication statusPublished - Mar 2008

Keywords

  • Hypopituitarism
  • Pituitary neoplasm
  • Pituitary surgery
  • Radiotherapy

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

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