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Comparison of Endoscopic Versus Microsurgical Resection of Pituitary Adenomas with Parasellar Extension and Evaluation of the Predictive Value of a Simple 4-Quadrant Radiologic Classification.
World Neurosurg 2019; 121:e769-e774WN

Abstract

BACKGROUND

The amount of parasellar extension is a known limitation for gross total resection (GTR) of pituitary adenomas. Endoscopic technique seems to improve resection of adenomas extending laterally. Knosp classification is used to evaluate the extent of parasellar invasion: increasing Knosp grades correspond with lower rates of GTR. The 4-quadrant method could help to estimate the risk of partial resection in adenomas with parasellar extension. The objective of this study was to compare the rate of GTR between microsurgical and endoscopic techniques in pituitary adenomas with parasellar extension. The secondary aim was to compare the predictive value of Knosp classification and of the 4-quadrant classification regarding GTR.

METHODS

This was a retrospective comparison of GTR in different Knosp grades and per quadrant in 55 consecutive patients who underwent microsurgical (n = 28, 2001-2008) or endoscopic (n = 27, 2008-2016) resection of a pituitary adenoma with parasellar extension.

RESULTS

The endoscopic group (19/27 patients) had a significant higher rate of GTR than the microsurgical group (8/28 patients) (P = 0.005). This was evident in all patients but those with Knosp grade 4. Using the quadrant classification, the endoscopic group had a significantly higher rate of GTR than the microsurgical group in all but the inferolateral quadrant. The 2 classifications showed similar sensitivity in predicting subtotal resection (78% quadrant vs. 82% Knosp), with limited specificity (both 25%).

CONCLUSIONS

GTR of macroadenomas with parasellar extension is significantly enhanced by the endoscopic approach. The 4-quadrant classification appears as sensitive as the Knosp classification and could be a simple adjunct to predict surgical radicality, in particular in cases of inferolateral quadrant invasion.

Authors+Show Affiliations

Department of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.Department of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Electronic address: vera.vigo@gmail.com.Department of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.Department of Otolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Otolaryngology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.Department of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.Department of Neurosurgery, Università degli Studi "G. D'Annunzio", Pescara, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30312824

Citation

Trevisi, Gianluca, et al. "Comparison of Endoscopic Versus Microsurgical Resection of Pituitary Adenomas With Parasellar Extension and Evaluation of the Predictive Value of a Simple 4-Quadrant Radiologic Classification." World Neurosurgery, vol. 121, 2019, pp. e769-e774.
Trevisi G, Vigo V, Morena MG, et al. Comparison of Endoscopic Versus Microsurgical Resection of Pituitary Adenomas with Parasellar Extension and Evaluation of the Predictive Value of a Simple 4-Quadrant Radiologic Classification. World Neurosurg. 2019;121:e769-e774.
Trevisi, G., Vigo, V., Morena, M. G., Grieco, D. L., Rigante, M., Anile, C., & Mangiola, A. (2019). Comparison of Endoscopic Versus Microsurgical Resection of Pituitary Adenomas with Parasellar Extension and Evaluation of the Predictive Value of a Simple 4-Quadrant Radiologic Classification. World Neurosurgery, 121, pp. e769-e774. doi:10.1016/j.wneu.2018.09.215.
Trevisi G, et al. Comparison of Endoscopic Versus Microsurgical Resection of Pituitary Adenomas With Parasellar Extension and Evaluation of the Predictive Value of a Simple 4-Quadrant Radiologic Classification. World Neurosurg. 2019;121:e769-e774. PubMed PMID: 30312824.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Endoscopic Versus Microsurgical Resection of Pituitary Adenomas with Parasellar Extension and Evaluation of the Predictive Value of a Simple 4-Quadrant Radiologic Classification. AU - Trevisi,Gianluca, AU - Vigo,Vera, AU - Morena,Maria Grazia, AU - Grieco,Domenico Luca, AU - Rigante,Mario, AU - Anile,Carmelo, AU - Mangiola,Annunziato, Y1 - 2018/10/09/ PY - 2018/05/12/received PY - 2018/09/27/revised PY - 2018/09/28/accepted PY - 2018/10/13/pubmed PY - 2019/1/3/medline PY - 2018/10/13/entrez KW - Cavernous sinus KW - Endoscopy KW - Gross total resection KW - Knosp classification KW - Microsurgery KW - Pituitary adenoma KW - Quadrants SP - e769 EP - e774 JF - World neurosurgery JO - World Neurosurg VL - 121 N2 - BACKGROUND: The amount of parasellar extension is a known limitation for gross total resection (GTR) of pituitary adenomas. Endoscopic technique seems to improve resection of adenomas extending laterally. Knosp classification is used to evaluate the extent of parasellar invasion: increasing Knosp grades correspond with lower rates of GTR. The 4-quadrant method could help to estimate the risk of partial resection in adenomas with parasellar extension. The objective of this study was to compare the rate of GTR between microsurgical and endoscopic techniques in pituitary adenomas with parasellar extension. The secondary aim was to compare the predictive value of Knosp classification and of the 4-quadrant classification regarding GTR. METHODS: This was a retrospective comparison of GTR in different Knosp grades and per quadrant in 55 consecutive patients who underwent microsurgical (n = 28, 2001-2008) or endoscopic (n = 27, 2008-2016) resection of a pituitary adenoma with parasellar extension. RESULTS: The endoscopic group (19/27 patients) had a significant higher rate of GTR than the microsurgical group (8/28 patients) (P = 0.005). This was evident in all patients but those with Knosp grade 4. Using the quadrant classification, the endoscopic group had a significantly higher rate of GTR than the microsurgical group in all but the inferolateral quadrant. The 2 classifications showed similar sensitivity in predicting subtotal resection (78% quadrant vs. 82% Knosp), with limited specificity (both 25%). CONCLUSIONS: GTR of macroadenomas with parasellar extension is significantly enhanced by the endoscopic approach. The 4-quadrant classification appears as sensitive as the Knosp classification and could be a simple adjunct to predict surgical radicality, in particular in cases of inferolateral quadrant invasion. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/30312824/Comparison_of_Endoscopic_Versus_Microsurgical_Resection_of_Pituitary_Adenomas_with_Parasellar_Extension_and_Evaluation_of_the_Predictive_Value_of_a_Simple_4_Quadrant_Radiologic_Classification_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(18)32270-8 DB - PRIME DP - Unbound Medicine ER -