Neurosurgery and pituitary resection in cancer patients

Abstract

Anterior pituitary neoplasms are the third most common brain tumor in the adult population and account for 10-25% of all intracranial tumors. Signs and symptoms exhibited by individuals with an anterior pituitary neoplasm are variable and dependent upon whether the lesion is a functional or nonfunctional tumor. Surgical resection of these tumors is the mainstay of treatment, along with close management of the various hormonal alterations seen in functional tumor types. The anesthetic management of these patients is largely concerned with alterations in anatomy and physiology that are the result of functional tumors. Of primary concern to the anesthesia provider are those individuals presenting with acromegaly or Cushing's disease. Acromegaly is particularly concerning given the changes in facial and airway features and often necessitates the use of advanced intubation techniques. Prognosis is related to tumor size with remission rates of 80-90% in patients with microadenomas and 40-70% in patients with macroadenomas.