5. The Radicality Of Pituitary Adenoma Removal In The Republic Of Kazakhstan

Аннотация

Background. Pituitary adenoma is a common tumor of the chiasmosellar region. By hormonal activity, pituitary adenoma’s are classified as somatotropinomas, non-functioning, prolactinomas, corticotropinomas, and mixed types. Treatment tactics vary by type. Objective: To assess radicality of removal of different pituitary adenoma types in patients operated.

Materials and methods. Retrospective analysis of 929 patients (721 — endoscopic transnasal approach) treated at JSC "National Centre for Neurosurgery" between 2010–2022. Clinical data and magnetic resonance imaging findings were evaluated.

Results. Significant differences in “Extent of Resection” were found among pituitary adenoma types. The highest rate of total resection occurred in mixed tumors compared to prolactinomas (76.5% vs 50%). Subtotal removal was seen in 23.5% of mixed tumors, none had partial resection. Prolactinomas showed total removal in 50%, subtotal in 41.9%, partial in 8.1%. Conservative resection of prolactinomas is linked to their high sensitivity to medical therapy, enabling full recovery with dopamine agonists postoperatively. More radical removal of mixed pituitary adenoma’s is justified by their aggressive behavior and relative drug resistance.

Conclusion. Extent of resection correlates with pituitary adenoma type. Lower radicality in prolactinomas reflects their benign course and responsiveness to drugs, whereas mixed pituitary adenoma’s require aggressive surgery due to severe hormonal disturbances. Greater radicality should be pursued when possible while preserving quality of life. The transnasal endoscopic approach remains the safest and most effective surgical method for pituitary adenoma’s in Kazakhstan, as confirmed by high total resection rates and low postoperative complications.