Oncotarget

Clinical Research Papers:

Clinical features and management of nonfunctioning giant pituitary adenomas causing hydrocephalus

Danfeng Zhang _, Jigang Chen, Zhenxing Li, Junyu Wang, Kaiwei Han and Lijun Hou

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Oncotarget. 2018; 9:15409-15417. https://doi.org/10.18632/oncotarget.24171

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Abstract

Danfeng Zhang1*, Jigang Chen1*, Zhenxing Li1*, Junyu Wang1, Kaiwei Han1 and Lijun Hou1

1Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China

*These authors contributed equally to this work

Correspondence to:

Lijun Hou, email: lijunhoucz@126.com

Kaiwei Han, email: toi@163.com

Junyu Wang, email: jerome2008@163.com

Keywords: nonfunctioning giant pituitary adenomas; hydrocephalus; clinical features; management; surgical approach

Received: July 31, 2017     Accepted: December 05, 2017     Epub: January 11, 2018     Published: March 16, 2018

ABSTRACT

We evaluated the features of clinically nonfunctioning giant pituitary adenomas (NFGPAs) causing hydrocephalus to highlight the timing of hydrocephalus management and surgical approaches. A total of 24 patients with NFGPAs and hydrocephalus were included. Eighteen patients underwent endoscopic transsphenoidal surgery. Ten patients received pterional surgery, including 6 patients as first treatment and 4 cases with recurrence after transsphenoidal approach. Gross total resection was achieved in 10 patients, including 6 cases (6/18, 33.3%) with endoscopic transsphenoidal surgery and 4 cases (4/10, 40%) with pterional surgery. All patients were divided into preoperative EVD group and non-preopoerative EVD group. The proportion of patients receiving postoperative EVD or shunt was significantly higher in non-preoperative EVD group than that in preoperative EVD group (9/15 vs. 1/9, P = 0.033). Visual impairment score (VIS) was evaluated for each patient. We detected significant vision improvement according to the preoperative and postoperative VIS (median, interquartile range: 62, 48.25–77 vs. 36.5, 0–50.75, P < 0.001). Conclusively, for patients with NFGPAs and hydrocephalus, preoperative EVD might reduce the need for a second shunt or EVD. Surgical approach should be decided based on the clinicoradiological features and surgeons’ experience for individualized treatment, and endoscopic transsphenoidal resection of pituitary adenomas was suggested for most NFGPAs.


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