SURGICAL, PHARMACOLOGICAL, RADIOLOGICAL AND COMBINED TREATMENT OF PITUITARY ADENOMAS
Authors: B. Kadashev, S. Alekseev, P. Kalinin, A. Shkarubo, M. Kutin, D. Fomichev
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Introduction: Adequate treatment of pituitary adenomas (PA) is possible only in specialized clinic
like Burdenko neurosurgical institute. Early diagnostic and combined treatment are most important in PA
Material and methods: We’ve treated more than 3000 patients during last 10 years. We used different surgical approaches (intra- and extradural transcranial, transsphenoidal, two-stage). Now at about 90% PA removed by transsphenoidal endoscopic approach.
Results: We have 90% radicality in small PA group. Radical removal and hormonal hypersecretion
normalisation is rare in cases with large and giant tumors particularly in cavernous sinus invasion. Large
(> 35mm) and giant (>60mm) PA are about 25% in our material. We saw correlation between radicalism
and recurrence rate. Total mortality is 1.5% and it rise up to 10% in giant (>60mm) PA. Prolactin-se creting PA (even in giant) we treat it by dopamine-agonist. Somatostatin-analogues we use in GH-tumors
like pre-operative treatment and in some cases after surgery. In cases of partial removal (particularly in hormonal active tumors), recurrence, or tumors with high mitotic activity (Ki-67 >3%), nuclear polymorphism we use post-op stereotactic radiotherapy. Gamma knife and LINAC like a first-step we use very rare. We regularly follow-up most of our patients for tumor control and adequate hormonal correction.
Conclusion: The optimal treatment choice (surgery, pharmacotherapy, radiotherapy or combined
treatment) could be taken commonly by neurosurgeon, endocrinologist and radiologist. Further
improvement of PA treatment depends on either surgical technique development or modern pharmacological and radiological methods evolution.