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Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas.
Neurosurg Focus 2011; 30(4):E10NF

Abstract

OBJECT

The purpose of this study was to analyze preoperative predictors of endocrinological remission following endonasal endoscopic resection of therapy-resistant prolactin-, growth hormone (GH)-, and adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas and to establish benchmarks for cure by using the most recent consensus criteria.

METHODS

The authors reviewed a prospective database of 86 consecutive functional pituitary adenomas that were resected by a purely endoscopic endonasal transsphenoidal technique. Extent of resection was evaluated on postoperative contrast-enhanced MR imaging. Endocrinological remission was defined according to the most recent consensus criteria.

RESULTS

The majority of functional adenomas (62.8%) were classified as macroadenomas (> 1 cm in maximum diameter), and 20.9% of lesions had invaded the cavernous sinus (CS) at the time of surgery. A gross-total resection was achieved in 75.6% of all patients. The rate of endocrinological remission differed between various types of functional adenomas. Cure rates were 92.3% (microadenomas) and 57.1% (macroadenomas) for prolactinomas, 75% (microadenomas) and 40% (macroadenomas) for GH-secreting tumors, and 54.5% (microadenomas) and 71.4% (macroadenomas) for ACTH-secreting tumors. Lower rates of cure occurred in GH-secreting macroadenomas due to a high rate of CS invasion, and in ACTH-secreting adenomas due to a high rate of lesions that were not visible on preoperative MR imaging. Whereas univariate analysis showed that macroadenoma, suprasellar, cavernous extension, or extent of resection correlated with cure, on multivariate analysis, only extent of resection and suprasellar extension predicted cure. One patient developed postoperative meningitis that was complicated by hydrocephalus requiring a ventriculoperitoneal shunt. Two patients developed postoperative panhypopituitarism, and 2 patients suffered from CSF leaks, which were treated with lumbar CSF diversion.

CONCLUSIONS

This paper reports benchmarks for endocrinological cure as well as complications in a large series of purely endoscopic pituitary surgeries by using the most recent consensus criteria. The advantages of extended endonasal approaches are most profound in tumors with suprasellar extension and CS invasion.

Authors+Show Affiliations

Department of Neurological Surgery, Weill Cornell Medical College, New York–Presbyterian Hospital, New York, New York 10021, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21456921

Citation

Hofstetter, Christoph P., et al. "Endoscopic Endonasal Transsphenoidal Surgery for Functional Pituitary Adenomas." Neurosurgical Focus, vol. 30, no. 4, 2011, pp. E10.
Hofstetter CP, Shin BJ, Mubita L, et al. Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas. Neurosurg Focus. 2011;30(4):E10.
Hofstetter, C. P., Shin, B. J., Mubita, L., Huang, C., Anand, V. K., Boockvar, J. A., & Schwartz, T. H. (2011). Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas. Neurosurgical Focus, 30(4), pp. E10. doi:10.3171/2011.1.FOCUS10317.
Hofstetter CP, et al. Endoscopic Endonasal Transsphenoidal Surgery for Functional Pituitary Adenomas. Neurosurg Focus. 2011;30(4):E10. PubMed PMID: 21456921.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas. AU - Hofstetter,Christoph P, AU - Shin,Benjamin J, AU - Mubita,Lynn, AU - Huang,Clark, AU - Anand,Vijay K, AU - Boockvar,John A, AU - Schwartz,Theodore H, PY - 2011/4/5/entrez PY - 2011/4/5/pubmed PY - 2011/7/30/medline SP - E10 EP - E10 JF - Neurosurgical focus JO - Neurosurg Focus VL - 30 IS - 4 N2 - OBJECT: The purpose of this study was to analyze preoperative predictors of endocrinological remission following endonasal endoscopic resection of therapy-resistant prolactin-, growth hormone (GH)-, and adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas and to establish benchmarks for cure by using the most recent consensus criteria. METHODS: The authors reviewed a prospective database of 86 consecutive functional pituitary adenomas that were resected by a purely endoscopic endonasal transsphenoidal technique. Extent of resection was evaluated on postoperative contrast-enhanced MR imaging. Endocrinological remission was defined according to the most recent consensus criteria. RESULTS: The majority of functional adenomas (62.8%) were classified as macroadenomas (> 1 cm in maximum diameter), and 20.9% of lesions had invaded the cavernous sinus (CS) at the time of surgery. A gross-total resection was achieved in 75.6% of all patients. The rate of endocrinological remission differed between various types of functional adenomas. Cure rates were 92.3% (microadenomas) and 57.1% (macroadenomas) for prolactinomas, 75% (microadenomas) and 40% (macroadenomas) for GH-secreting tumors, and 54.5% (microadenomas) and 71.4% (macroadenomas) for ACTH-secreting tumors. Lower rates of cure occurred in GH-secreting macroadenomas due to a high rate of CS invasion, and in ACTH-secreting adenomas due to a high rate of lesions that were not visible on preoperative MR imaging. Whereas univariate analysis showed that macroadenoma, suprasellar, cavernous extension, or extent of resection correlated with cure, on multivariate analysis, only extent of resection and suprasellar extension predicted cure. One patient developed postoperative meningitis that was complicated by hydrocephalus requiring a ventriculoperitoneal shunt. Two patients developed postoperative panhypopituitarism, and 2 patients suffered from CSF leaks, which were treated with lumbar CSF diversion. CONCLUSIONS: This paper reports benchmarks for endocrinological cure as well as complications in a large series of purely endoscopic pituitary surgeries by using the most recent consensus criteria. The advantages of extended endonasal approaches are most profound in tumors with suprasellar extension and CS invasion. SN - 1092-0684 UR - https://www.unboundmedicine.com/medline/citation/21456921/Endoscopic_endonasal_transsphenoidal_surgery_for_functional_pituitary_adenomas_ L2 - https://thejns.org/doi/10.3171/2011.1.FOCUS10317 DB - PRIME DP - Unbound Medicine ER -