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Surgical Outcome of Growth Hormone-Secreting Pituitary Adenoma with Empty Sella Using a New Classification.
World Neurosurg. 2017 Sep; 105:651-658.WN

Abstract

OBJECTIVE

To investigate outcomes and identified risk factors affecting cure and intraoperative cerebrospinal fluid leak after transsphenoidal surgery using a new classification for growth hormone-secreting pituitary adenoma associated with empty sella.

METHODS

In this retrospective cohort study, 51 patients enrolled from January 2010 to June 2016 were categorized into 3 groups using a new classification scheme: grade A, whole tumor occupation area beneath a horizontal line drawn along the lowest level of empty sella; grade B, tumor occupation area that crossed the horizontal line on 1 side; and grade C, tumor occupation area that crossed the horizontal line on 2 sides. Clinical data were collected and analyzed.

RESULTS

Cure rate for grade A patients (88.24%; 15/17) was significantly higher than cure rate for grade B (55.00%; 11/20) and grade C (50.00%; 7/14) patients. Occurrence of cerebrospinal fluid leaks in grade C patients (35.71%; 5/14) was higher than in grade A patients (5.88%; 1/17). Logistic regression analysis indicated that risk factors affecting cure included large maximum tumor diameter (P = 0.009, odds ratio [OR] = 1.222), high preoperative fasting growth hormone level (P = 0.031, OR = 1.088), and high classification (P = 0.017, OR = 4.485). Risk factor affecting intraoperative cerebrospinal fluid leak was high classification (P = 0.039, OR = 3.580).

CONCLUSIONS

Transsphenoidal surgery is the current optimal treatment strategy. Empty sella increases the difficulty of surgery with a higher incidence of complications. The new classification scheme was better for predicting the surgical outcome for this disease.

Authors+Show Affiliations

Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China; Peking Union Medical College, Beijing, China.Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China; Peking Union Medical College, Beijing, China.Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China; Peking Union Medical College, Beijing, China.Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China; Peking Union Medical College, Beijing, China.Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China.Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China.Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China.Department of Endocrinology, Peking Union Medical College Hospital, Beijing, China.Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China; China Pituitary Disease Registry Center, Chinese Pituitary Adenoma Cooperative Group, Beijing, China. Electronic address: xingbingemail@aliyun.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28642181

Citation

Wang, Qiang, et al. "Surgical Outcome of Growth Hormone-Secreting Pituitary Adenoma With Empty Sella Using a New Classification." World Neurosurgery, vol. 105, 2017, pp. 651-658.
Wang Q, Guo X, Gao L, et al. Surgical Outcome of Growth Hormone-Secreting Pituitary Adenoma with Empty Sella Using a New Classification. World Neurosurg. 2017;105:651-658.
Wang, Q., Guo, X., Gao, L., Wang, Z., Deng, K., Lian, W., Wang, R., Zhu, H., & Xing, B. (2017). Surgical Outcome of Growth Hormone-Secreting Pituitary Adenoma with Empty Sella Using a New Classification. World Neurosurgery, 105, 651-658. https://doi.org/10.1016/j.wneu.2017.06.071
Wang Q, et al. Surgical Outcome of Growth Hormone-Secreting Pituitary Adenoma With Empty Sella Using a New Classification. World Neurosurg. 2017;105:651-658. PubMed PMID: 28642181.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical Outcome of Growth Hormone-Secreting Pituitary Adenoma with Empty Sella Using a New Classification. AU - Wang,Qiang, AU - Guo,Xiaopeng, AU - Gao,Lu, AU - Wang,Zihao, AU - Deng,Kan, AU - Lian,Wei, AU - Wang,Renzhi, AU - Zhu,Huijuan, AU - Xing,Bing, Y1 - 2017/06/19/ PY - 2017/04/11/received PY - 2017/06/11/revised PY - 2017/06/13/accepted PY - 2017/6/24/pubmed PY - 2017/10/5/medline PY - 2017/6/24/entrez KW - Biochemical cure KW - Cerebrospinal fluid leak KW - Empty sella KW - Growth hormone-secreting pituitary adenoma KW - Transsphenoidal surgery SP - 651 EP - 658 JF - World neurosurgery JO - World Neurosurg VL - 105 N2 - OBJECTIVE: To investigate outcomes and identified risk factors affecting cure and intraoperative cerebrospinal fluid leak after transsphenoidal surgery using a new classification for growth hormone-secreting pituitary adenoma associated with empty sella. METHODS: In this retrospective cohort study, 51 patients enrolled from January 2010 to June 2016 were categorized into 3 groups using a new classification scheme: grade A, whole tumor occupation area beneath a horizontal line drawn along the lowest level of empty sella; grade B, tumor occupation area that crossed the horizontal line on 1 side; and grade C, tumor occupation area that crossed the horizontal line on 2 sides. Clinical data were collected and analyzed. RESULTS: Cure rate for grade A patients (88.24%; 15/17) was significantly higher than cure rate for grade B (55.00%; 11/20) and grade C (50.00%; 7/14) patients. Occurrence of cerebrospinal fluid leaks in grade C patients (35.71%; 5/14) was higher than in grade A patients (5.88%; 1/17). Logistic regression analysis indicated that risk factors affecting cure included large maximum tumor diameter (P = 0.009, odds ratio [OR] = 1.222), high preoperative fasting growth hormone level (P = 0.031, OR = 1.088), and high classification (P = 0.017, OR = 4.485). Risk factor affecting intraoperative cerebrospinal fluid leak was high classification (P = 0.039, OR = 3.580). CONCLUSIONS: Transsphenoidal surgery is the current optimal treatment strategy. Empty sella increases the difficulty of surgery with a higher incidence of complications. The new classification scheme was better for predicting the surgical outcome for this disease. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/28642181/Surgical_Outcome_of_Growth_Hormone_Secreting_Pituitary_Adenoma_with_Empty_Sella_Using_a_New_Classification_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(17)30963-4 DB - PRIME DP - Unbound Medicine ER -