Efficacy of Trans-septal Trans-sphenoidal Surgery in Correcting Visual Symptoms Caused by Hematogenous Metastases to the Sella and Pituitary Gland

 

 Buy Article Permissions and Reprints

ABSTRACT

The rate of symptomatic improvement of visual symptoms associated with hematogenous metastases to the sella and pituitary was evaluated retrospectively in seven patients (five men, two women; mean age, 52.3 years) with primarily visual symptoms (diplopia alone in three, diplopia with blurred vision in one, blurred vision alone in one, loss of peripheral vision in one, and unilateral complete blindness in one). Symptom duration ranged from 0.5 to 2 months. The primary diseases were non-small cell lung cancer in two patients, renal cell carcinoma in two patients, prostate cancer in two patients, and medullary thyroid carcinoma in one patient. All patients had widespread metastatic disease. Three patients had a suprasellar tumoral component. One patient had a clival extension, and one patient had extension into the cavernous sinus. All underwent trans-sphenoidal surgery to correct visual symptoms. Gross total resection was achieved in three patients. Subtotal resections and a partial resection were performed in three patients and one patient, respectively. Surgical blood loss averaged 282 mL. One patient died from sepsis. Five patients developed complications (cerebrospinal fluid leakage in three, diabetes insipidus in two, anterior pituitary dysfunction in two, and colitis in one). At a mean follow-up of 15 months, three patients were alive. Visual symptoms improved in five patients and were unchanged in two. Trans-sphenoidal surgery helped improve visual symptoms in most patients. The morbidity rate was high and likely related to the locally destructive and extensive nature of the lesions in overall morbid patients with widespread metastatic disease. Unless nonoperative measures can provide equal results, however, this approach provides reasonable palliation.

REFERENCES

• 1 Kovacs K. Metastatic cancer of the pituitary gland.  Oncology. 1973;  27 533-542
  PubMedGoogle Scholar
• 2 Abrams H L, Spiro R, Goldstein N. Metastases in carcinoma: analysis of 1000 autopsied cases.  Cancer. 1950;  3 74-85
  CrossrefPubMedGoogle Scholar
• 3 Heshmati H M, Scheithauer B W, Young Jr W F. Metastases to the pituitary gland.  Endocrinologist. 2002;  12 45-49
  PubMedGoogle Scholar
• 4 Teears R J, Silverman E M. Clinicopathologic review of 88 cases of carcinoma metastatic to the pituitary gland.  Cancer. 1975;  36 216-220
  CrossrefPubMedGoogle Scholar
• 5 Komninos J, Vlassopoulou V, Protopapa D et al.. Tumors metastatic to the pituitary gland: case report and literature review.  J Clin Endocrinol Metab. 2004;  89 574-580
  CrossrefPubMedGoogle Scholar
• 6 Juneau P, Schoene W C, Black P. Malignant tumors in the pituitary gland.  Arch Neurol. 1992;  49 555-558
  PubMedGoogle Scholar
• 7 Landolt A M. Comments on: Nelson PB, Robinson AG, Martinez AJ. Metastatic tumor of the pituitary gland.  Neurosurgery. 1987;  21 941-944
  PubMedGoogle Scholar
• 8 McCormick P C, Post K D, Kandji A D, Hays A P. Metastatic carcinoma to the pituitary gland.  Br J Neurosurg. 1989;  3 71-79
  CrossrefPubMedGoogle Scholar
• 9 Gsponer J, De Tribolet N, Deruaz J P et al.. Diagnosis, treatment, and outcome of pituitary tumors and other abnormal intrasellar masses: retrospective analysis of 353 patients.  Medicine (Baltimore). 1999;  78 236-269
  CrossrefPubMedGoogle Scholar
• 10 Branch Jr C L, Laws Jr E R. Metastatic tumors of the sella turcica masquerading as primary pituitary tumors.  J Clin Endocrinol Metab. 1987;  65 469-474
  PubMedGoogle Scholar
• 11 Max M B, Deck M D, Rottenberg D A. Pituitary metastasis: incidence in cancer patients and clinical differentiation from pituitary adenoma.  Neurology. 1981;  31 998-1002
  PubMedGoogle Scholar
• 12 Houck W A, Olson K B, Horton J. Clinical features of tumor metastasis to the pituitary.  Cancer. 1970;  26 656-659
  CrossrefPubMedGoogle Scholar
• 13 Sioutos P, Yen V, Arbit E. Pituitary gland metastases.  Ann Surg Oncol. 1996;  3 94-99
  CrossrefPubMedGoogle Scholar
• 14 Morita A, Meyer F B, Laws Jr E R. Symptomatic pituitary metastases.  J Neurosurg. 1998;  89 69-73
  CrossrefPubMedGoogle Scholar
• 15 Fassett D R, Couldwell W T. Metastases to the pituitary gland.  Neurosurg Focus. 2004;  16 E8
  CrossrefPubMedGoogle Scholar
• 16 McCutcheon I E, Waguespack S G, Fuller G N, Couldwell W T. Metastatic melanoma to the pituitary gland.  Can J Neurol Sci. 2007;  34 322-327
  PubMedGoogle Scholar
• 17 McCutcheon I E, Kitagawa R H, Sherman S I, Bruner J M. Adenocarcinoma of the salivary gland metastatic to the pituitary gland: case report.  Neurosurgery. 2001;  48 1161-1165
  CrossrefPubMedGoogle Scholar
• 18 Marin F, Kovacs K T, Scheithauer B W, Young Jr W F. The pituitary gland in patients with breast carcinoma: a histologic and immunocytochemical study of 125 cases.  Mayo Clin Proc. 1992;  67 949-956
  PubMedGoogle Scholar
• 19 Post K D, McCormick P C, Hays A P, Kandji A G. Metastatic carcinoma to pituitary adenoma: report of two cases.  Surg Neurol. 1988;  30 286-292
  CrossrefPubMedGoogle Scholar
• 20 Weber J, Gassel A M, Hoch A, Spring A. Concomitant renal cell carcinoma with pituitary adenoma.  Acta Neurochir (Wien). 2003;  145 227-231
  CrossrefPubMedGoogle Scholar
• 21 Molinatti P A, Scheithauer B W, Randall R V, Laws Jr E R. Metastasis to pituitary adenoma.  Arch Pathol Lab Med. 1985;  109 287-289
  PubMedGoogle Scholar
• 22 McDermott R S, Anderson P R, Greenberg R E, Milestone B N, Hudes G R. Cranial nerve deficits in patients with metastatic prostate carcinoma: clinical features and treatment outcomes.  Cancer. 2004;  101 1639-1643
  CrossrefPubMedGoogle Scholar
• 23 Murata Y, Ogawa Y, Yokoe I et al.. Pituitary stalk metastasis from breast cancer treated with systemic chemotherapy.  Oncol Rep. 2003;  10 1973-1975
  PubMedGoogle Scholar
• 24 Patel N, Teh B S, Powell S, Lu H H, Amato R, Butler E B. Rare case of metastatic prostate adenocarcinoma to the pituitary.  Urology. 2003;  62 352
  PubMedGoogle Scholar
• 25 Iwai Y, Yamanaka K, Honda Y, Matsusaka Y. Radiosurgery for pituitary metastases.  Neurol Med Chir (Tokyo). 2004;  44 112-116
  CrossrefPubMedGoogle Scholar
• 26 Piedra M P, Brown P D, Carpenter P C, Link M J. Resolution of diabetes insipidus following gamma knife surgery for a solitary metastasis to the pituitary stalk: case report.  J Neurosurg. 2004;  101 1053-1056
  CrossrefPubMedGoogle Scholar
• 27 Losa M, Grasso M, Giugni E, Mortini P, Acerno S, Giovanelli M. Metastatic prostatic adenocarcinoma presenting as a pituitary mass: shrinkage of the lesion and clinical improvement with medical treatment.  Prostate. 1997;  32 241-245
  CrossrefPubMedGoogle Scholar
• 28 Kattah J C, Silgals R M, Manz H, Toro J G, Dritschilo A, Smith F P. Presentation and management of parasellar and suprasellar metastatic mass lesions.  J Neurol Neurosurg Psychiatry. 1985;  48 44-49
  PubMedGoogle Scholar

Ian E McCutcheonM.D. 

Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center

PO Box 301402, Unit 442, Houston, TX 77230-1402

Email: imccutch@mdanderson.org