Pituitary metastases surgery [Neurosurgery Wiki]

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====== Pituitary metastases surgery ======

Surgical treatment of PM should be specifically decided based on patient performance status, tumor staging, and patient preference
((Zoli M, Mazzatenta D, Faustini-Fustini M, Pasquini E, Frank G. Pituitary metastases: role of surgery. World Neurosurg. 2013 Feb;79(2):327-30. doi: 10.1016/j.wneu.2012.03.018. Epub 2012 Apr 2. PMID: 22480977.)).

The [[transsphenoidal approach]] is a safe method to resect pituitary metastases and that the extend of resection does not have an influence on survival time
((Burkhardt T, Henze M, Kluth LA, Westphal M, Schmidt NO, Flitsch J. Surgical management of pituitary metastases. Pituitary. 2016 Feb;19(1):11-8. doi: 10.1007/s11102-015-0676-z. PMID: 26238305.)).
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Complete surgical [[resection]] of PMs is usually impossible because these [[metastases]] are often diffuse and invasive, but surgery is still indicated when suprasellar extension of a metastases results in chiasmal damage and visual deterioration, or when the histological assessment of the [[sellar tumor]] is required for the precise diagnosis of primary cancer and decision on the preferred treatment. Surgery by the trans-sphenoidal route can improve visual-field defects, headache, and ophthalmoplegia in the majority of affected cases. Stereotactic sellar [[radiosurgery]] is also an effective, non-invasive, and safe method of ameliorating the compressive symptoms of PMs in patients with widespread metastases and expected short [[survival]]
((Kano H, Niranjan A, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for pituitary metastases. Surg Neurol. 2009 Sep;72(3):248-55; discussion 255-6. doi: 10.1016/j.surneu.2008.06.003. Epub 2008 Sep 11. PMID: 18786712.)).
Definitive tissue diagnosis by surgery may prevent unnecessary radiotherapy to the sellae or the need for other systemic treatments when benign pituitary disease is confirmed histologically
((Goulart CR, Upadhyay S, Ditzel Filho LFS, Beer-Furlan A, Carrau RL, Prevedello LM, Prevedello DM. Newly Diagnosed Sellar Tumors in Patients with Cancer: A Diagnostic Challenge and Management Dilemma. World Neurosurg. 2017 Oct;106:254-265. doi: 10.1016/j.wneu.2017.06.139. Epub 2017 Jun 30. PMID: 28673886.)).
Surgery with/or sellar radiation can improve local symptoms but are not expected to increase the survival rate, thus the treatment aim is mostly palliative.

The anterior pituitary function should be carefully studied and hormonal replacement initiated as required. Diabetes insipidus treated with desmopressin (administered nasally or orally) can improve the quality of life and prevent sodium/water imbalance. Systemic targeted medical treatment is usually not efficient when diffuse metastatic spread together with PM is apparent. However, patients with pituitary involvement by melanoma, lymphoma, or leukemia may potentially benefit from chemotherapy or immunotherapy if diagnosed and treated appropriately
((McCutcheon IE, Waguespack SG, Fuller GN, Couldwell WT. Metastatic melanoma to the pituitary gland. Can J Neurol Sci. 2007 Aug;34(3):322-7. doi: 10.1017/s0317167100006752. PMID: 17803030.))
((Kenchaiah M, Hyer SL. Diffuse large B-cell non Hodgkin's lymphoma in a 65-year-old woman presenting with hypopituitarism and recovering after chemotherapy: a case report. J Med Case Rep. 2011 Oct 4;5:498. doi: 10.1186/1752-1947-5-498. PMID: 21970824; PMCID: PMC3197538.)).