Abstract
Introduction:
Symptomatic metastases to the pituitary gland and sella often present with pituitary insufficiency and visual symptoms.
Methods:
Between 2000 and 2005, 8 patients (6 males, 2 females; mean age 52 y) presented with visual symptoms (diplopia in 4, diminished acuity in 2, field cuts in 2, and complete blindness in 1) associated with metastases to the pituitary gland and sella. Symptom duration ranged from 0.5 to 2 months. Primary disease were non-small cell lung cancer (n = 2), renal carcinoma (n = 2), prostate cancer (n = 2), and medullary thyroid carcinoma and cutaneous melanoma each in 1. All patients had widespread metastatic disease. All underwent trans-sphenoidal surgery for correction of visual symptoms. Study design consisted of a retrospective chart review.
Results:
A suprasellar component was present in 3 and clivus and cavernous sinus extensions were noted in 1 each. A gross total resection was achieved in 3, and subtotal and partial resection was performed in 3 and 2, respectively. Blood loss averaged 300 cc. One patient died from sepsis. Six patients suffered from complications (CSF leak in 3, diabetes insipidus in 3, anterior pituitary dysfunction in 2, and colitis in 1). Mean follow-up was 14 months. Half were alive. Visual symptoms improved in 6 and were unchanged in 2.
Conclusions:
Trans-sphenoidal surgery was effective in improving visual symptoms in most patients. Morbidity 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, this approach provides reasonable palliation.