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Parasellar Extension Grades and Surgical Extent in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas : A Single Surgeon's Consecutive Series with the Aspects of Reliability and Clinical Validity.
J Korean Neurosurg Soc 2016; 59(6):577-583JK

Abstract

OBJECTIVE

The inter-rater reliability of the modified Knosp's classification was measured before the analysis. The clinical validity of the parasellar extension grading system was evaluated by investigating the extents of resection and complication rates among the grades in the endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenomas.

METHODS

From November 2008 to August 2015, of the 286 patients who underwent EETS by the senior author, 208 were pituitary adenoma cases (146 non-functioning pituitary adenomas, 10 adrenocorticotropic hormone-secreting adenomas, 31 growth hormone-secreting adenomas, 17 prolactin-secreting adenomas, and 4 thyroid-stimulating hormone-secreting adenomas; 23 microadenomas, 174 macroadenomas, and 11 giant adenomas). Two neurosurgeons and a neuroradiologist independently measured the degree of parasellar extension on the preoperative sellar MRI according to the modified Knosp's classification. Inter-rater reliability was statistically assessed by measuring the intraclass correlation coefficient. The extents of resection were evaluated by comparison of the pre- and post-operative MR images; the neurovascular complications were assessed by reviewing the patients' medical records. The extent of resection was measured in each parasellar extension grade; thereafter, their statistical differences were calculated.

RESULTS

The intraclass correlation coefficient value of reliability across the three raters amounted to 0.862. The gross total removal (GTR) rates achieved in each grade were 70.0, 69.8, 62.9, 21.4, 37.5, and 4.3% in Grades 0, 1, 2, 3A, 3B, and 4, respectively. A significant difference in the extent of resection was observed only between Grades 2 and 3A. In addition, significantly higher complication rates were observed in the groups above Grade 3A.

CONCLUSION

Although the modified Knosp's classification system appears to be complex, its inter-rater reliability proves to be excellent. Regarding the clinical validity of the parasellar extension grading system, Grades 3A, 3B, and 4 have a negative predictive value for the GTR rate, with higher complication rates.

Authors+Show Affiliations

Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.Department of Otorhinolaryngology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27847570

Citation

Lee, Sang-Hyo, et al. "Parasellar Extension Grades and Surgical Extent in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas : a Single Surgeon's Consecutive Series With the Aspects of Reliability and Clinical Validity." Journal of Korean Neurosurgical Society, vol. 59, no. 6, 2016, pp. 577-583.
Lee SH, Park JS, Lee S, et al. Parasellar Extension Grades and Surgical Extent in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas : A Single Surgeon's Consecutive Series with the Aspects of Reliability and Clinical Validity. J Korean Neurosurg Soc. 2016;59(6):577-583.
Lee, S. H., Park, J. S., Lee, S., Kim, S. W., & Hong, Y. K. (2016). Parasellar Extension Grades and Surgical Extent in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas : A Single Surgeon's Consecutive Series with the Aspects of Reliability and Clinical Validity. Journal of Korean Neurosurgical Society, 59(6), pp. 577-583.
Lee SH, et al. Parasellar Extension Grades and Surgical Extent in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas : a Single Surgeon's Consecutive Series With the Aspects of Reliability and Clinical Validity. J Korean Neurosurg Soc. 2016;59(6):577-583. PubMed PMID: 27847570.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Parasellar Extension Grades and Surgical Extent in Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Adenomas : A Single Surgeon's Consecutive Series with the Aspects of Reliability and Clinical Validity. AU - Lee,Sang-Hyo, AU - Park,Jae-Sung, AU - Lee,Song, AU - Kim,Sung-Won, AU - Hong,Yong-Kil, Y1 - 2016/10/24/ PY - 2016/05/05/received PY - 2016/05/09/revised PY - 2016/08/02/accepted PY - 2016/11/17/entrez PY - 2016/11/17/pubmed PY - 2016/11/17/medline KW - Cavernous sinus KW - Complications KW - Endoscopy KW - Pituitary neoplasms KW - Reliability KW - Transsphenoidal surgery SP - 577 EP - 583 JF - Journal of Korean Neurosurgical Society JO - J Korean Neurosurg Soc VL - 59 IS - 6 N2 - OBJECTIVE: The inter-rater reliability of the modified Knosp's classification was measured before the analysis. The clinical validity of the parasellar extension grading system was evaluated by investigating the extents of resection and complication rates among the grades in the endoscopic endonasal transsphenoidal surgery (EETS) for pituitary adenomas. METHODS: From November 2008 to August 2015, of the 286 patients who underwent EETS by the senior author, 208 were pituitary adenoma cases (146 non-functioning pituitary adenomas, 10 adrenocorticotropic hormone-secreting adenomas, 31 growth hormone-secreting adenomas, 17 prolactin-secreting adenomas, and 4 thyroid-stimulating hormone-secreting adenomas; 23 microadenomas, 174 macroadenomas, and 11 giant adenomas). Two neurosurgeons and a neuroradiologist independently measured the degree of parasellar extension on the preoperative sellar MRI according to the modified Knosp's classification. Inter-rater reliability was statistically assessed by measuring the intraclass correlation coefficient. The extents of resection were evaluated by comparison of the pre- and post-operative MR images; the neurovascular complications were assessed by reviewing the patients' medical records. The extent of resection was measured in each parasellar extension grade; thereafter, their statistical differences were calculated. RESULTS: The intraclass correlation coefficient value of reliability across the three raters amounted to 0.862. The gross total removal (GTR) rates achieved in each grade were 70.0, 69.8, 62.9, 21.4, 37.5, and 4.3% in Grades 0, 1, 2, 3A, 3B, and 4, respectively. A significant difference in the extent of resection was observed only between Grades 2 and 3A. In addition, significantly higher complication rates were observed in the groups above Grade 3A. CONCLUSION: Although the modified Knosp's classification system appears to be complex, its inter-rater reliability proves to be excellent. Regarding the clinical validity of the parasellar extension grading system, Grades 3A, 3B, and 4 have a negative predictive value for the GTR rate, with higher complication rates. SN - 2005-3711 UR - https://www.unboundmedicine.com/medline/citation/27847570/Parasellar_Extension_Grades_and_Surgical_Extent_in_Endoscopic_Endonasal_Transsphenoidal_Surgery_for_Pituitary_Adenomas_:_A_Single_Surgeon's_Consecutive_Series_with_the_Aspects_of_Reliability_and_Clinical_Validity_ L2 - http://jkns.or.kr/journal/view.php?doi=10.3340/jkns.2016.59.6.577 DB - PRIME DP - Unbound Medicine ER -