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Extent of Resection, Visual, and Endocrinologic Outcomes for Endoscopic Endonasal Surgery for Recurrent Pituitary Adenomas.
World Neurosurg 2017; 102:35-41WN

Abstract

OBJECTIVE

To assess outcomes after endoscopic endonasal surgery for recurrent or residual pituitary adenomas.

METHODS

We retrospectively analyzed 61 patients from 2009 to 2016 who underwent endoscopic endonasal surgery for recurrent or residual pituitary adenomas after previous microscopic or endoscopic transsphenoidal operation.

RESULTS

The previous surgical approach was endoscopic endonasal in 55.7% and microscopic in 44.2% of patients. The mean preoperative maximal tumor diameter was 2.3 cm. Tumor commonly invaded the suprasellar cistern (63.9%). Gross total resection (GTR) was achieved in 31 patients (51.7%). GTR rate was 68.4% and 21.7% for Knosp grade 0-2 and grade 3-4 tumors, respectively (P < 0.001). GTR was 73.1% and 35.3% for patients with previous microscopic and endoscopic transsphenoidal surgery, respectively (P = 0.002). On multivariate analysis, smaller tumor size (odds ratio [OR], 1.1 per cm; P = 0.007), Knosp grade 0-2 (OR, 9.7; P = 0.002), and previous microscopic approach (OR, 12.7; P = 0.007) were independent predictors of GTR. Preoperative visual deficit outcome was improved in 32.5%, unchanged in 62.5%, and worse in 5.0%. New postoperative endocrinopathies included adrenal insufficiency (6.5%), hypothyroidism (8.1%), hypogonadism (6.5%), and diabetes insipidus (4.9%). Complications included postoperative cerebrospinal fluid leak (4.9%), meningitis (1.6%), medical complications (4.9%), and postoperative hematoma requiring re-exploration (3.2%).

CONCLUSIONS

The endoscopic endonasal approach provides a safe and effective option for recurrent pituitary adenomas. Smaller tumor size, absence of cavernous sinus invasion, and previous microscopic approach were independent predictors of GTR. This finding might suggest that inadequate exposure or limited viewing angle may adversely affect extent of resection in primary microscopic surgeries.

Authors+Show Affiliations

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA; Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio, USA.Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Department of Ophthalmology, NYU Langone Medical Center, New York, New York, USA.Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA; Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA; Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. Electronic address: james.evans@jefferson.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28286277

Citation

Do, Hyunwoo, et al. "Extent of Resection, Visual, and Endocrinologic Outcomes for Endoscopic Endonasal Surgery for Recurrent Pituitary Adenomas." World Neurosurgery, vol. 102, 2017, pp. 35-41.
Do H, Kshettry VR, Siu A, et al. Extent of Resection, Visual, and Endocrinologic Outcomes for Endoscopic Endonasal Surgery for Recurrent Pituitary Adenomas. World Neurosurg. 2017;102:35-41.
Do, H., Kshettry, V. R., Siu, A., Belinsky, I., Farrell, C. J., Nyquist, G., ... Evans, J. J. (2017). Extent of Resection, Visual, and Endocrinologic Outcomes for Endoscopic Endonasal Surgery for Recurrent Pituitary Adenomas. World Neurosurgery, 102, pp. 35-41. doi:10.1016/j.wneu.2017.02.131.
Do H, et al. Extent of Resection, Visual, and Endocrinologic Outcomes for Endoscopic Endonasal Surgery for Recurrent Pituitary Adenomas. World Neurosurg. 2017;102:35-41. PubMed PMID: 28286277.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extent of Resection, Visual, and Endocrinologic Outcomes for Endoscopic Endonasal Surgery for Recurrent Pituitary Adenomas. AU - Do,Hyunwoo, AU - Kshettry,Varun R, AU - Siu,Alan, AU - Belinsky,Irina, AU - Farrell,Christopher J, AU - Nyquist,Gurston, AU - Rosen,Marc, AU - Evans,James J, Y1 - 2017/03/09/ PY - 2016/12/26/received PY - 2017/02/26/revised PY - 2017/02/28/accepted PY - 2017/3/14/pubmed PY - 2017/9/25/medline PY - 2017/3/14/entrez KW - Endocrine KW - Resection KW - Revision KW - Transnasal KW - Transsphenoidal KW - Vision SP - 35 EP - 41 JF - World neurosurgery JO - World Neurosurg VL - 102 N2 - OBJECTIVE: To assess outcomes after endoscopic endonasal surgery for recurrent or residual pituitary adenomas. METHODS: We retrospectively analyzed 61 patients from 2009 to 2016 who underwent endoscopic endonasal surgery for recurrent or residual pituitary adenomas after previous microscopic or endoscopic transsphenoidal operation. RESULTS: The previous surgical approach was endoscopic endonasal in 55.7% and microscopic in 44.2% of patients. The mean preoperative maximal tumor diameter was 2.3 cm. Tumor commonly invaded the suprasellar cistern (63.9%). Gross total resection (GTR) was achieved in 31 patients (51.7%). GTR rate was 68.4% and 21.7% for Knosp grade 0-2 and grade 3-4 tumors, respectively (P < 0.001). GTR was 73.1% and 35.3% for patients with previous microscopic and endoscopic transsphenoidal surgery, respectively (P = 0.002). On multivariate analysis, smaller tumor size (odds ratio [OR], 1.1 per cm; P = 0.007), Knosp grade 0-2 (OR, 9.7; P = 0.002), and previous microscopic approach (OR, 12.7; P = 0.007) were independent predictors of GTR. Preoperative visual deficit outcome was improved in 32.5%, unchanged in 62.5%, and worse in 5.0%. New postoperative endocrinopathies included adrenal insufficiency (6.5%), hypothyroidism (8.1%), hypogonadism (6.5%), and diabetes insipidus (4.9%). Complications included postoperative cerebrospinal fluid leak (4.9%), meningitis (1.6%), medical complications (4.9%), and postoperative hematoma requiring re-exploration (3.2%). CONCLUSIONS: The endoscopic endonasal approach provides a safe and effective option for recurrent pituitary adenomas. Smaller tumor size, absence of cavernous sinus invasion, and previous microscopic approach were independent predictors of GTR. This finding might suggest that inadequate exposure or limited viewing angle may adversely affect extent of resection in primary microscopic surgeries. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/28286277/Extent_of_Resection_Visual_and_Endocrinologic_Outcomes_for_Endoscopic_Endonasal_Surgery_for_Recurrent_Pituitary_Adenomas_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(17)30305-4 DB - PRIME DP - Unbound Medicine ER -