Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 12:13:857314.
doi: 10.3389/fendo.2022.857314. eCollection 2022.

Surgical Experience of Transcranial Approaches to Large-to-Giant Pituitary Adenomas in Knosp Grade 4

Xiudong Guan  1 , Yangyang Wang  1 , Chengkai Zhang  1 , Shunchang Ma  2 , Wenjianlong Zhou  1 , Guijun Jia  1 , Wang Jia  1   2
Affiliations

Surgical Experience of Transcranial Approaches to Large-to-Giant Pituitary Adenomas in Knosp Grade 4

Xiudong Guan et al. Front Endocrinol (Lausanne). .

Abstract

Pituitary adenomas in Knosp grade 4 are difficult to resect completely and are generally involved in poor prognosis, because of the close relationship between the tumor and internal carotid. In this study, the authors retrospectively reviewed the outcome of different transcranial approaches in the management of large-to-giant pituitary adenomas in Knosp grade 4. A total of 42 patients with large-to-giant pituitary adenomas in Knosp grade 4, who underwent craniotomy in the Pituitary Disease Subdivision, Department of Neurosurgery, Beijing Tiantan Hospital, between March 2012 and March 2015 were included in this study. Clinical characteristics, surgical methods, complications, and outcomes were evaluated. The median age was 45 years (range, 19-73 years old), and 42.9% of the enrolled cases were men. The mean tumor diameter was 43.6 mm, and the mean volume was 30.9 cm3. 26 patients underwent the frontolateral approach, while 16 cases accepted the frontotemporal approach. Gross total resection was achieved in 11 patients (26.2%), near total in 26 (61.9%), and subtotal in 5 (11.9%). The adenomas were larger, and the distance of the tumor extending to the lateral skull base was also further in the frontotemporal approach cases. The surgical time was shorter, and the bleeding volume was less in the frontolateral approach cases. Subsellar extension was associated with incomplete resection in pituitary macroadenomas of Knosp grade 4. The craniotomy is still an effective treatment for pituitary macroadenomas in Knosp grade 4.

Keywords: Knosp grade 4; frontolateral approach; frontotemporal approach; outcome; pituitary macroadenoma; transcranial approach.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Schematic diagrams and MRI images of frontolateral approach. Schematic diagrams of incision, surgical field, and microanatomy of frontolateral approach (A). Preoperative (B) and 3-month postoperative (C) coronal enhanced MRI images of a giant pituitary adenoma in Knosp grade 4 that underwent the frontolateral approach.
Figure 2
Figure 2
Schematic diagram and MRI images of the frontotemporal approach. Schematic diagrams of incision, surgical field, and microanatomy of frontolateral approach (A). Preoperative (B) and 3-month postoperative (C) coronal enhanced MRI images of a giant pituitary adenoma in Knosp grade 4 that underwent the frontotemporal approach.
Figure 3
Figure 3
Tumor size in the patients who underwent different surgical approaches. (A) The maximum diameter of tumors in two groups. (B) The tumor volume in two groups. (C) The distance of tumors expanding to the lateral skull base (Student t-test, P < 0.05).
See this image and copyright information in PMC

References

    1. Kovacs K, Horvath E. Pathology of Pituitary Tumors. Endocrinol Metab Clin North Am (1987) 16(3):529–51. doi: 10.1016/S0889-8529(18)30463-8 - DOI - PubMed
    1. Wilson CB. A Decade of Pituitary Microsurgery. The Herbert Olivecrona Lecture. J Neurosurg (1984) 61(5):814–33. doi: 10.3171/jns.1984.61.5.0814 - DOI - PubMed
    1. Knosp E, Steiner E, Kitz K, Matula C. Pituitary Adenomas With Invasion of the Cavernous Sinus Space: A Magnetic Resonance Imaging Classification Compared With Surgical Findings. Neurosurgery (1993) 33(4):610–7; discussion 7-8. doi: 10.1227/00006123-199310000-00008 - DOI - PubMed
    1. Fahlbusch R, Buchfelder M. Transsphenoidal Surgery of Parasellar Pituitary Adenomas. Acta Neurochirurgica (1988) 92(1-4):93–9. doi: 10.1007/BF01401978 - DOI - PubMed
    1. Eseonu CI, ReFaey K, Rincon-Torroella J, Garcia O, Wand GS, Salvatori R, et al. . Endoscopic Versus Microscopic Transsphenoidal Approach for Pituitary Adenomas: Comparison of Outcomes During the Transition of Methods of a Single-Surgeon. World Neurosurg (2016) 97:317–25. doi: 10.1016/j.wneu.2016.09.120 - DOI - PubMed

Publication types