Surgical approaches in pituitary neuroendocrine tumors

Abstract

Introduction. Pituitary neuroendocrine tumors account for 3.9-7.4/100.000 of central nervous system tumors in the Western world. They are particularly noteworthy, comprising 10-15% of all cases, with a higher prevalence in the 75-79 age group. In the Republic of Moldova, these tumors account for 34% of cases in postmortem examinations while remain an actual theme of discussion in the ENDO WHO congress and are regarded as a factor, which may influence the quality of life (QOL). Material and methods. We have critically revised 66 literary sources, which were selected using the PubMed library after introducing the keywords “pituitary adenoma surgical approach”. Results. The main surgical approaches were the transsphenoidal (transnasal, sublabial and endonasal) and transcranial (subfrontal unilateral/bilateral, fronto-lateral, fronto-temporal and median basilar) while the additional surgical approaches were designed for complicated and unusual pituitary neuroendocrine tumors and included combined versions, multiple surgeries or extended approaches. Numerous factors were influential for the selection of a surgical approach concerning the pituitary neuroendocrine tumors. They are not sensible for a type of pituitary neuroendocrine tumor according to the WHO classification while the size of a tumor may dictate its surgical approach. Conclusion. Each surgical intervention requires a personalized approach and the critical thinking of the surgical team but most of them can be systematically considered before confronting the tumor in an intraoperatory environment because most of the preoperatory investigations are proven unreliable. There is no established superior surgical approach for each surgical intervention.