Surgical management of pituicytomas: case series and comprehensive literature review
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Pituicytomas are rare neoplasms that typically present as solid, noninfiltrative tumors occupying the sella and/or suprasellar space for which there is no consensus on optimal surgical management. We aimed to define a preferred surgical strategy for these tumors based on our clinical experience and comprehensive review of the world literature.
Case series and review of the literature.
We documented the clinical, radiographic, and surgical findings of three patients with pituicytoma treated at our institution, as well as complications and long-term outcomes. A comprehensive review of the medical literature identified all cases of pituicytoma for which data regarding surgical approach, outcome and complications could be extracted. We compared our results with published data.
All three cases at our institution achieved gross total removal. Two patients underwent an expanded endoscopic endonasal transsphenoidal and transplanum (EETS-TP) approach, while one tumor was removed via craniotomy. Post-operatively all patients developed pan-hypopitutarism. The patient undergoing craniotomy suffered profound visual loss but no other neurological complications were noted. A literature review identified 67 reported cases of pituicytoma. Surgical data was available in 60 cases. Surgical approach was documented in 57 patients. Sixty-three surgeries were performed in which approach and extent of resection was available. Gross total removal was obtained in 33 % of craniotomies, 42 % of transsphenoidal procedures, and 100 % of expanded transsphenoidal procedures. Neurological complications including visual loss, hemiparesis and cranial nerve palsies were reported after craniotomy, but not after transsphenoidal approaches. Overall EETS-TP approaches were associated with the highest rate of gross total removal and no visual or neurological complications.
EETS-TP surgery is the preferred strategy for surgical removal of pituicytoma. EETS-TP and transsphenoidal approaches are associated with higher rates of gross total removal and lower rates of neurological complications than craniotomy. Gross total removal should be the intended goal of surgery.
KeywordsPituicytoma Outcome Complications Endoscope Transsphenoidal Craniotomy
Epithelial membrane antigen
Glial fibrillary acidic protein
Endoscopic endonasal transsphenoidal transplanum
Conflict of interest
The authors report no conflicts of interest or financial disclosures/nothing to declare.
- 5.Secci F, Merciadri P, Rossi DC, D’Andrea A, Zona G (2012) Pituicytomas: radiological findings, clinical behavior and surgical management. Acta Neurochir (Wien) 154:649–657, discussion 657Google Scholar
- 9.Watanabe K (2000) Granular-cell tumor (choristoma, pituicytoma). Ryoikibetsu Shokogun Shirizu 28(Pt 3):218–219 Google Scholar
- 10.Ellis JA, Tsankova NM, D’Amico R, Ausiello JC, Canoll P, Rosenblum MK, Bruce JN (2012) Epithelioid pituicytoma. World Neurosurg 78(191):E191–E197Google Scholar
- 18.Hurley TR, D’Angelo CM, Clasen RA, Wilkinson SB, Passavoy RD (1994) Magnetic resonance imaging and pathological analysis of a pituicytoma: case report. Neurosurgery 35:314–317, discussion 317Google Scholar
- 19.Ulm AJ, Yachnis AT, Brat DJ, Rhoton Jr AL (2004) Pituicytoma: report of two cases and clues regarding histogenesis. Neurosurgery 54:753–757, discussion 757–758Google Scholar
- 31.Wolfe SQ, Bruce J, Morcos JJ (2008) Pituicytoma: case report. Neurosurgery 63:E173–E174, discussion E174Google Scholar
- 35.Huynh N, Stemmer-Rachamimov AO, Swearingen B, Cestari DM (2012) Decreased vision and junctional scotoma from pituicytoma: case report. Ophthalmol 3:190–196Google Scholar
- 46.Munich SA, Fenstermaker RA, Fabiano AJ, Rigual NR (2013) Cranial base repair with combined vascularized nasal septal flap and autologous tissue graft following expanded endonasal endoscopic neurosurgery. J Neurol Surg A Cent Eur Neurosurg 74(2):101–108Google Scholar
- 50.Elliott RE, Jane Jr JA, Wisoff JH (2011) Surgical management of craniopharyngiomas in children: meta-analysis and comparison of transcranial and transsphenoidal approaches. Neurosurgery 69:630–643, discussion 643Google Scholar
- 51.Mascarenhas L, Moshel YA, Bayad F, Szentirmai O, Salek AA, Leng LZ, Hofstetter CP, Placantonakis DG, Tsiouris AJ, Anand VK, Schwartz TH (2013) The transplanum transtuberculum approaches for suprasellar and sellar-suprasellar lesions: avoidance of cerebrospinal fluid leak and lessons learned. World Neurosurg. doi: 10.1016/j.wneu.2013.02.032