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Challenging Knosp high-grade pituitary adenomas.
J Neurosurg 2019; :1-8JN

Abstract

OBJECTIVE

Parasellar growth is one of the most important prognostic variables of pituitary adenoma surgery, with adenomas regarded as not completely resectable if they invade the cavernous sinus (CS) but potentially curable if they displace CS structures. This study was conducted to correlate surgical treatment options and outcomes to the different biological behaviors (invasion vs displacement) of adenomas with parasellar extension into the superior or inferior CS compartments or completely encasing the carotid artery (Knosp high grades 3A, 3B, and 4).

METHODS

This was a retrospective cohort analysis of 106 consecutive patients with Knosp high-grade pituitary adenomas with parasellar extension who underwent surgery via a primary endoscopic transsphenoidal approach between 2003 and 2017. Biological tumor characteristics (surgical status of invasiveness and tumor texture, 2017 WHO classification, proliferation rate), extent of resection, and complication rate were correlated with parasellar extension grades 3A, 3B, and 4 on preoperative MRI studies.

RESULTS

Invasiveness was significantly less common in grade 3A (44%) than in grade 3B (72%, p = 0.037) and grade 4 (100%, p < 0.001) adenomas. Fibrous tumor texture was significantly more common in grade 4 (52%) compared to grade 3A (20%, p = 0.002), but not compared to grade 3B (28%) adenomas. Functioning macroadenomas had a significantly higher rate of invasiveness than nonfunctioning adenomas (91% vs 55%, p = 0.002). Mean proliferation rate assessed by MIB-1 was > 3% in all groups but without significant difference between the groups (grade 3A, 3.2%; 3B, 3.9%; 4, 3.7%). Rates of endocrine remission/gross-total resection were significantly higher in grade 3A (64%) than in grade 3B (33%, p = 0.021) and grade 4 (0%, p < 0.001) adenomas. In terms of complication rates, no significant difference was observed between grades.

CONCLUSIONS

According to the authors' data, the biological behavior of pituitary adenomas varies significantly between parasellar extension patterns. Adenomas with extension into the superior CS compartment have a lower rate of invasive growth than adenomas extending into the inferior CS compartment or encasing the carotid artery. Consequently, a significantly higher rate of remission can be achieved in grade 3A than in grade 3B and grade 4 adenomas. Therefore, the distinction into grades 3A, 3B, and 4 is of importance for prediction of adenoma invasion and surgical treatment considerations.

Authors+Show Affiliations

1Department of Neurosurgery.1Department of Neurosurgery.2Center for Anatomy and Cell Biology.3Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, and.4Institute of Neurology, Medical University Vienna, Vienna, Austria.1Department of Neurosurgery.1Department of Neurosurgery.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31151112

Citation

Micko, Alexander, et al. "Challenging Knosp High-grade Pituitary Adenomas." Journal of Neurosurgery, 2019, pp. 1-8.
Micko A, Oberndorfer J, Weninger WJ, et al. Challenging Knosp high-grade pituitary adenomas. J Neurosurg. 2019.
Micko, A., Oberndorfer, J., Weninger, W. J., Vila, G., Höftberger, R., Wolfsberger, S., & Knosp, E. (2019). Challenging Knosp high-grade pituitary adenomas. Journal of Neurosurgery, pp. 1-8. doi:10.3171/2019.3.JNS19367.
Micko A, et al. Challenging Knosp High-grade Pituitary Adenomas. J Neurosurg. 2019 May 31;1-8. PubMed PMID: 31151112.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Challenging Knosp high-grade pituitary adenomas. AU - Micko,Alexander, AU - Oberndorfer,Johannes, AU - Weninger,Wolfgang J, AU - Vila,Greisa, AU - Höftberger,Romana, AU - Wolfsberger,Stefan, AU - Knosp,Engelbert, Y1 - 2019/05/31/ PY - 2019/02/13/received PY - 2019/03/04/accepted PY - 2019/6/1/entrez KW - CS = cavernous sinus KW - ER = endocrine remission KW - GTR = gross-total resection KW - ICA = internal carotid artery KW - Knosp grading KW - cavernous sinus KW - invasion KW - pituitary adenoma KW - pituitary surgery SP - 1 EP - 8 JF - Journal of neurosurgery JO - J. Neurosurg. N2 - OBJECTIVEParasellar growth is one of the most important prognostic variables of pituitary adenoma surgery, with adenomas regarded as not completely resectable if they invade the cavernous sinus (CS) but potentially curable if they displace CS structures. This study was conducted to correlate surgical treatment options and outcomes to the different biological behaviors (invasion vs displacement) of adenomas with parasellar extension into the superior or inferior CS compartments or completely encasing the carotid artery (Knosp high grades 3A, 3B, and 4).METHODSThis was a retrospective cohort analysis of 106 consecutive patients with Knosp high-grade pituitary adenomas with parasellar extension who underwent surgery via a primary endoscopic transsphenoidal approach between 2003 and 2017. Biological tumor characteristics (surgical status of invasiveness and tumor texture, 2017 WHO classification, proliferation rate), extent of resection, and complication rate were correlated with parasellar extension grades 3A, 3B, and 4 on preoperative MRI studies.RESULTSInvasiveness was significantly less common in grade 3A (44%) than in grade 3B (72%, p = 0.037) and grade 4 (100%, p < 0.001) adenomas. Fibrous tumor texture was significantly more common in grade 4 (52%) compared to grade 3A (20%, p = 0.002), but not compared to grade 3B (28%) adenomas. Functioning macroadenomas had a significantly higher rate of invasiveness than nonfunctioning adenomas (91% vs 55%, p = 0.002). Mean proliferation rate assessed by MIB-1 was > 3% in all groups but without significant difference between the groups (grade 3A, 3.2%; 3B, 3.9%; 4, 3.7%). Rates of endocrine remission/gross-total resection were significantly higher in grade 3A (64%) than in grade 3B (33%, p = 0.021) and grade 4 (0%, p < 0.001) adenomas. In terms of complication rates, no significant difference was observed between grades.CONCLUSIONSAccording to the authors' data, the biological behavior of pituitary adenomas varies significantly between parasellar extension patterns. Adenomas with extension into the superior CS compartment have a lower rate of invasive growth than adenomas extending into the inferior CS compartment or encasing the carotid artery. Consequently, a significantly higher rate of remission can be achieved in grade 3A than in grade 3B and grade 4 adenomas. Therefore, the distinction into grades 3A, 3B, and 4 is of importance for prediction of adenoma invasion and surgical treatment considerations. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/31151112/Challenging_Knosp_high_grade_pituitary_adenomas_ L2 - https://thejns.org/doi/10.3171/2019.3.JNS19367 DB - PRIME DP - Unbound Medicine ER -