Endocrinological outcome after pituitary transposition (hypophysopexy) and adjuvant radiotherapy for tumors involving the cavernous sinus

Abstract

The increased distance between the normal pituitary gland and the residual tumor facilitates treatment of the tumor with radiosurgery or radiotherapy and effectively reduces the incidence of radiation injury to the normal pituitary gland when compared with historical controls.

Update on prolactinomas. Part 2: Treatment and management strategies

“…The incidence of new anterior hypopituitarism after radiosurgery has also been reported to be as high as 28-42% [65,67]. The risk of radiation-induced hypopituitarism can potentially be reduced by performing a pituitary transposition (hypophysopexy), if a sellar exploration is performed [69][70][71]. This involves the placement of a fat graft between the normal pituitary gland and the residual tumor in the cavernous sinus, which increases the distance of the normal gland from the radiosurgical target, thereby, reducing the effective biological dose to the normal gland.…”

Endoscopic endonasal resection of skull base meningiomas: the significance of a “cortical cuff” and brain edema compared with careful case selection and surgical experience in predicting morbidity and extent of resection

“…The utility of this type of pituitary transposition or "hypophysopexy" has been described by other authors. 9,36,48 Figure 3 demonstrates examples of sellar and cavernous meningiomas suitable for endonasal surgery.…”

Intraoperative fat placement in surgically refractory parasellar neoplasms to facilitate stereotactic radiosurgery

“…While this technique imposes a risk of infection, it is likely a low one, given the overall safety history of fat packing and fat used to mark other neuroanatomical structures [13,17]. Moreover, the autologous fat transplant was already implemented for fat packing to prevent CSF leaks in each of our cases.…”

“…More importantly, this fat can also help to increase and maintain the distance of the tumor from the chiasm to the neoplasm. The use of fat to increase the distance between sellar or parasellar tumors and the pituitary gland itself, called pituitary transposition or hypophysopexy, has been described and shown to decrease radiation-induced endocrinopathies [2,11,17]. Thus, increased distance between the tumor and chiasm may similarly mitigate the risk of SRS-induced optic neuropathy.…”