Transsphenoidal Surgery for Secreting Pituitary Microadenomas: Results with Intraoperative Application of Absolute Alcohol
Author(s)
Mario F. Fraioli1*,
Andrea Pagano1,
Giuseppe Giovinazzo2,
Pierpaolo Lunardi1,
Bernardo Fraioli3
Affiliation(s)
1 Department of Neurosurgery, University of Rome Tor Vergata, Rome, Italy. 2 Department of Radiotherapy, IFO Regina Elena of Rome, Rome, Italy. 3 Department of Radiology and Radiotherapy, CIRAD Villa Benedetta of Rome, Rome, Italy.
1 Department of Neurosurgery, University of Rome Tor Vergata, Rome, Italy. 2 Department of Radiotherapy, IFO Regina Elena of Rome, Rome, Italy. 3 Department of Radiology and Radiotherapy, CIRAD Villa Benedetta of Rome, Rome, Italy.
ABSTRACT
Background: Pituitary adenomas represent a quite frequent neurosurgical disease. Secreting pituitary adenomas are represented by PRL, GH, ACTH and TSH tumours; the rate of postoperative hormonal recurrence is not ineligible. Methods: We present 106 patients affected by secreting pituitary microadenomas operated through transsphenoidal approach from 1998 through to 2008; in 54 (group 1) patients, intraoperative absolute alcohol was applied, while in the other 52 (group 2) it was not employed. The indications and the intraoperative technique of absolute alcohol application are presented. Hormonal recurrence was treated by hypofractionated stereotactic radiotherapy and/or medical therapy. Results: Postoperative hormonal and clinical remission was achieved in 50 and 47 patients respectively of group one and group two. At the first follow-up control, after 3 months from surgery, no patient of both groups presented hormonal/clinical recurrence. Six months after surgery, no patient of group one presented hormonal recurrence, while two patients of group 2 presented hormonal recurrence. After 2 years from surgery, two patients of group 1 and 4 patients of group 2 presented hormonal recurrence. Three years after operation, hormonal hypersecretion recurred in three patients of group one and in six patients of group 2. At 5 years follow-up, six patients of group one and 8 of group two presented hormonal recurrence. Conclusions: Intraoperative application of absolute alcohol, in selected cases, resulted useful to achieve better results in secreting pituitary microadenomas concerning both postoperative hormonal recurrence and hormonal persistence.
Background: Pituitary adenomas represent a quite frequent neurosurgical disease. Secreting pituitary adenomas are represented by PRL, GH, ACTH and TSH tumours; the rate of postoperative hormonal recurrence is not ineligible. Methods: We present 106 patients affected by secreting pituitary microadenomas operated through transsphenoidal approach from 1998 through to 2008; in 54 (group 1) patients, intraoperative absolute alcohol was applied, while in the other 52 (group 2) it was not employed. The indications and the intraoperative technique of absolute alcohol application are presented. Hormonal recurrence was treated by hypofractionated stereotactic radiotherapy and/or medical therapy. Results: Postoperative hormonal and clinical remission was achieved in 50 and 47 patients respectively of group one and group two. At the first follow-up control, after 3 months from surgery, no patient of both groups presented hormonal/clinical recurrence. Six months after surgery, no patient of group one presented hormonal recurrence, while two patients of group 2 presented hormonal recurrence. After 2 years from surgery, two patients of group 1 and 4 patients of group 2 presented hormonal recurrence. Three years after operation, hormonal hypersecretion recurred in three patients of group one and in six patients of group 2. At 5 years follow-up, six patients of group one and 8 of group two presented hormonal recurrence. Conclusions: Intraoperative application of absolute alcohol, in selected cases, resulted useful to achieve better results in secreting pituitary microadenomas concerning both postoperative hormonal recurrence and hormonal persistence.
Cite this paper
Fraioli, M. , Pagano, A. , Giovinazzo, G. , Lunardi, P. and Fraioli, B. (2014) Transsphenoidal Surgery for Secreting Pituitary Microadenomas: Results with Intraoperative Application of Absolute Alcohol. International Journal of Clinical Medicine, 5, 1111-1117. doi: 10.4236/ijcm.2014.517142.
Fraioli, M. , Pagano, A. , Giovinazzo, G. , Lunardi, P. and Fraioli, B. (2014) Transsphenoidal Surgery for Secreting Pituitary Microadenomas: Results with Intraoperative Application of Absolute Alcohol. International Journal of Clinical Medicine, 5, 1111-1117. doi: 10.4236/ijcm.2014.517142.
References
[1] Ezzat, S., Asa, S.L., Couldwell, W.T., Barr, C.E., Dodge, W.E., Vance, M.L. and McCutcheon, I.E. (2004) The Prevalence of Pituitary Adenomas: A Systematic Review. Cancer, 101, 613-619.
http://dx.doi.org/10.1002/cncr.20412 [2] Kreutzer, J. and Fahlbusch, R. (2004) Diagnosis and Treatment of Pituitary Tumors. Current Opinion in Neurology, 17, 693-703.
http://dx.doi.org/10.1097/00019052-200412000-00009 [3] Liu, J.K. and Couldwell, W.T. (2004) Contemporary Management of Prolactinomas. Neurosurgical Focus, 16, E2.
http://dx.doi.org/10.3171/foc.2004.16.4.3 [4] Philippon, M., Castinettia, F. and Bruea, T. (2013) Cushing’s Disease with Negative Imaging in Adults. Annales d’Endocrinologie (Paris), 74, S23-S32.
http://dx.doi.org/10.1016/S0003-4266(13)70018-0 [5] Patil, C.G., Prevedello, D.M., Lad, S.P., Vance, M.L., Thorner, M.O., Katznelson, L. and Laws Jr., E.R. (2008) Late Recurrences of Cushing’s Disease after Initial Successful Transsphenoidal Surgery. The Journal of Clinical Endocrinology and Metabolism, 93, 358-362.
http://dx.doi.org/10.1210/jc.2007-2013 [6] Colao, A., Boscaro, M., Ferone, D. and Casanueva, F.F. (2014) Managing Cushing’s Disease: The State of the Art. Endocrine. [7] Ding, D., Starke, R.M. and Sheehan, J.P. (2013) Treatment Paradigms for Pituitary Adenomas: Defining the Roles of Radiosurgery and Radiation Therapy. Journal of Neuro-Oncology, 117, 445-457. [8] Jallad, R.S. and Bronstein, M.D. (2013) The Place of Medical Treatment of Acromegaly: Current Status and Perspectives. Expert Opinion on Pharmacotherapy, 14, 1001-1015.
http://dx.doi.org/10.1517/14656566.2013.784744 [9] Stapleton, C.J., Liu, C.Y. and Weiss, M.H. (2010) The Role of Stereotactic Radiosurgery in the Multimodal Management of Growth Hormone-Secreting Pituitary Adenomas. Neurosurg Focus, 29, E11. [10] Wilson, P.J., Williams, J.R. and Smee, R.I. (2014) Cushing’s Disease: A Single Centre’s Experience Using the Linear Accelerator (LINAC) for Stereotactic Radiosurgery and Fractionated Stereotactic Radiotherapy. Journal of Clinical Neuroscience, 21, 100-106.
http://dx.doi.org/10.1016/j.jocn.2013.04.007 [11] Amar, A.P., Couldwell, W.T., Chen, C.T. and Weiss, M.H. (2002) Predictive Value of Serum Prolactin Levels Measured Immediately after Transsphenoidal Surgery. Journal of Neurosurgery, 97, 307-314.
http://dx.doi.org/10.3171/jns.2002.97.2.0307 [12] Chen, C.T., Amar, A.P., Choi, S., Singer, P., Couldwell, W.T. and Weiss, M.H. (2003) Transsphenoidal Microsurgical Treatment of Cushing Disease: Postoperative Assessment of Surgical Efficacy by Application of an Overnight Low-Dose Dexamethasone Suppression Test. Journal of Neurosurgery, 98, 967-973.
http://dx.doi.org/10.3171/jns.2003.98.5.0967 [13] Ross, D. and Wilson, C.B. (1988) Results of Transsphenoidal Microsurgery for Growth Hormone-Secreting Pituitary Adenoma in a Series of 214 Patients. Journal of Neurosurgery, 68, 854-867.
http://dx.doi.org/10.3171/jns.1988.68.6.0854 [14] Selman, W., Laws Jr., E.R., Scheithauer, B.W. and Carpente, S.M. (1986) The Occurrence of Dural Invasion in Pituitary Adenomas. Journal of Neurosurgery, 64, 402-407.
http://dx.doi.org/10.3171/jns.1986.64.3.0402 [15] Wislawski, J., Kasperlik-Zaluska, A.A., Jeske, W., Migdalska, B., Janik, J., Zaluska, J. and Bonicki, W. (1985) Results of Neurosurgical Treatment by a Transsphenoidal Approach in 10 Patients with Nelson’s Syndrome. Journal of Neurosurgery, 62, 68-71. http://dx.doi.org/10.3171/jns.1985.62.1.0068 [16] Greco, T. (1965) Alcoholization of the Hypophysis in Treatment of Malignant Tumors. Advantages of this Method and Conclusive Considerations. Ospedali d’Italia-Chirurgia, 12, 439-448. [17] Greco, T., Sbaragli, F. and Mininni, D. (1965) Alcoholization of the Hypophysis in Thyroid Cancer. Ospedali d’Italia-Chirurgia, 12, 425-427. [18] Lloyd, J.W., Rawlinson, W.A. and Evans, P.J. (1981) Selective Hypophysectomy for Metastatic Pain. A Review of Ethyl Alcohol Ablation of the Anteriorpituitary in a Regional Pain Relief Unit. British Journal of Anaesthesia, 53, 1129-1133.
http://dx.doi.org/10.1093/bja/53.11.1129 [19] Sorrentino, F. (1965) Alcoholization of the Pituitary Gland in the Treatment of Prostatic Cancer. Urologia Internationalis, 19, 47-53.
http://dx.doi.org/10.1159/000279269
[1] Ezzat, S., Asa, S.L., Couldwell, W.T., Barr, C.E., Dodge, W.E., Vance, M.L. and McCutcheon, I.E. (2004) The Prevalence of Pituitary Adenomas: A Systematic Review. Cancer, 101, 613-619.
http://dx.doi.org/10.1002/cncr.20412 [2] Kreutzer, J. and Fahlbusch, R. (2004) Diagnosis and Treatment of Pituitary Tumors. Current Opinion in Neurology, 17, 693-703.
http://dx.doi.org/10.1097/00019052-200412000-00009 [3] Liu, J.K. and Couldwell, W.T. (2004) Contemporary Management of Prolactinomas. Neurosurgical Focus, 16, E2.
http://dx.doi.org/10.3171/foc.2004.16.4.3 [4] Philippon, M., Castinettia, F. and Bruea, T. (2013) Cushing’s Disease with Negative Imaging in Adults. Annales d’Endocrinologie (Paris), 74, S23-S32.
http://dx.doi.org/10.1016/S0003-4266(13)70018-0 [5] Patil, C.G., Prevedello, D.M., Lad, S.P., Vance, M.L., Thorner, M.O., Katznelson, L. and Laws Jr., E.R. (2008) Late Recurrences of Cushing’s Disease after Initial Successful Transsphenoidal Surgery. The Journal of Clinical Endocrinology and Metabolism, 93, 358-362.
http://dx.doi.org/10.1210/jc.2007-2013 [6] Colao, A., Boscaro, M., Ferone, D. and Casanueva, F.F. (2014) Managing Cushing’s Disease: The State of the Art. Endocrine. [7] Ding, D., Starke, R.M. and Sheehan, J.P. (2013) Treatment Paradigms for Pituitary Adenomas: Defining the Roles of Radiosurgery and Radiation Therapy. Journal of Neuro-Oncology, 117, 445-457. [8] Jallad, R.S. and Bronstein, M.D. (2013) The Place of Medical Treatment of Acromegaly: Current Status and Perspectives. Expert Opinion on Pharmacotherapy, 14, 1001-1015.
http://dx.doi.org/10.1517/14656566.2013.784744 [9] Stapleton, C.J., Liu, C.Y. and Weiss, M.H. (2010) The Role of Stereotactic Radiosurgery in the Multimodal Management of Growth Hormone-Secreting Pituitary Adenomas. Neurosurg Focus, 29, E11. [10] Wilson, P.J., Williams, J.R. and Smee, R.I. (2014) Cushing’s Disease: A Single Centre’s Experience Using the Linear Accelerator (LINAC) for Stereotactic Radiosurgery and Fractionated Stereotactic Radiotherapy. Journal of Clinical Neuroscience, 21, 100-106.
http://dx.doi.org/10.1016/j.jocn.2013.04.007 [11] Amar, A.P., Couldwell, W.T., Chen, C.T. and Weiss, M.H. (2002) Predictive Value of Serum Prolactin Levels Measured Immediately after Transsphenoidal Surgery. Journal of Neurosurgery, 97, 307-314.
http://dx.doi.org/10.3171/jns.2002.97.2.0307 [12] Chen, C.T., Amar, A.P., Choi, S., Singer, P., Couldwell, W.T. and Weiss, M.H. (2003) Transsphenoidal Microsurgical Treatment of Cushing Disease: Postoperative Assessment of Surgical Efficacy by Application of an Overnight Low-Dose Dexamethasone Suppression Test. Journal of Neurosurgery, 98, 967-973.
http://dx.doi.org/10.3171/jns.2003.98.5.0967 [13] Ross, D. and Wilson, C.B. (1988) Results of Transsphenoidal Microsurgery for Growth Hormone-Secreting Pituitary Adenoma in a Series of 214 Patients. Journal of Neurosurgery, 68, 854-867.
http://dx.doi.org/10.3171/jns.1988.68.6.0854 [14] Selman, W., Laws Jr., E.R., Scheithauer, B.W. and Carpente, S.M. (1986) The Occurrence of Dural Invasion in Pituitary Adenomas. Journal of Neurosurgery, 64, 402-407.
http://dx.doi.org/10.3171/jns.1986.64.3.0402 [15] Wislawski, J., Kasperlik-Zaluska, A.A., Jeske, W., Migdalska, B., Janik, J., Zaluska, J. and Bonicki, W. (1985) Results of Neurosurgical Treatment by a Transsphenoidal Approach in 10 Patients with Nelson’s Syndrome. Journal of Neurosurgery, 62, 68-71. http://dx.doi.org/10.3171/jns.1985.62.1.0068 [16] Greco, T. (1965) Alcoholization of the Hypophysis in Treatment of Malignant Tumors. Advantages of this Method and Conclusive Considerations. Ospedali d’Italia-Chirurgia, 12, 439-448. [17] Greco, T., Sbaragli, F. and Mininni, D. (1965) Alcoholization of the Hypophysis in Thyroid Cancer. Ospedali d’Italia-Chirurgia, 12, 425-427. [18] Lloyd, J.W., Rawlinson, W.A. and Evans, P.J. (1981) Selective Hypophysectomy for Metastatic Pain. A Review of Ethyl Alcohol Ablation of the Anteriorpituitary in a Regional Pain Relief Unit. British Journal of Anaesthesia, 53, 1129-1133.
http://dx.doi.org/10.1093/bja/53.11.1129 [19] Sorrentino, F. (1965) Alcoholization of the Pituitary Gland in the Treatment of Prostatic Cancer. Urologia Internationalis, 19, 47-53.
http://dx.doi.org/10.1159/000279269