Predictors of visual and endocrine outcomes after endoscopic transsphenoidal surgery for pituitary adenomas

Abstract Background Pituitary adenomas (PAs) are the second most common brain tumors, 10% to 20% of all primary brain tumors. Transsphenoidal approach is now the gold standard for treatment of PAs either microscopic or endoscopic. Aim of the Work to analyze the collective outcomes from studies comparing the microscopic transsphenoidal surgery (MTS) with the endoscopic transsphenoidal surgery (ETS) regarding gross total resection (GTR) and postoperative cerebrospinal fluid (CSF) leak. Patients and Methods we searched PubMed, Google scholar search engine, Cochrane database of systematic reviews, EMBASE and science Direct, using the following keywords “Pituitary adenoma/tumor, endoscopy or endoscopic, microscopy or microscopic, gross total/subtotal/near total/radicular resection/excision, hypophysectomy, debulking, CSF leak/leakage ". The mentioned databases were searched for studies published during period from the 1st of Jan 2015 to 31 Aug. 2020. Results Total number of patients in included studies was 1211 of which 621 (51.3%) underwent endoscopic surgery and 590 (48.7%) underwent microscopic surgery. Of 990 patient analysed for GTR, it was achieved in 334 patients (69.4%) in endoscopic group compared with 287 patients (56.4%) in microscopic group. Of 1211 patients, Postoperative CSF leak developed in 30 patients (5.7%) compared with 32 patients (4.7%) in endoscopic and microscopic group respectively. Conclusion GTR was found to be slightly higher in the endoscopic group especially in cases of suprasellar and lateral cavernous extensions. CSF leak showed no significant difference between the two groups.

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A randomized controlled trial to determine the role of intraoperative lumbar cerebrospinal fluid drainage in patients undergoing endoscopic transsphenoidal surgery for pituitary adenomas

Neurology India ◽

10.4103/0028-3886.222823 ◽

2018 ◽

Vol 66 (1) ◽

pp. 133 ◽

Cited By ~ 4

Author(s):

AriGeorge Chacko ◽

GandhamE Jonathan ◽

Sauradeep Sarkar ◽

Georgene Singh ◽

Sunithi Mani ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cerebrospinal Fluid ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Controlled Trial ◽

Cerebrospinal Fluid Drainage ◽

Endoscopic Transsphenoidal Surgery ◽

Randomized Controlled ◽

Lumbar Cerebrospinal Fluid

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Axis-specific analysis and predictors of endocrine recovery and deficits for non-functioning pituitary adenomas undergoing endoscopic transsphenoidal surgery

Pituitary ◽

10.1007/s11102-020-01045-z ◽

2020 ◽

Vol 23 (4) ◽

pp. 389-399 ◽

Cited By ~ 1

Author(s):

Jenie Y. Hwang ◽

Diane J. Aum ◽

Michael R. Chicoine ◽

Ralph G. Dacey ◽

Joshua W. Osbun ◽

...

Keyword(s):

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Endoscopic Transsphenoidal Surgery ◽

Specific Analysis ◽

Non Functioning Pituitary Adenomas

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Pure endoscopic transsphenoidal surgery for treatment of acromegaly: results of 67 cases treated in a pituitary center

Neurosurgical FOCUS ◽

10.3171/2010.7.focus10167 ◽

2010 ◽

Vol 29 (4) ◽

pp. E7 ◽

Cited By ~ 61

Author(s):

Jackson A. Gondim ◽

João Paulo Almeida ◽

Lucas Alverne F. de Albuquerque ◽

Erika Gomes ◽

Michele Schops ◽

...

Keyword(s):

Growth Factor ◽

Disease Control ◽

Endoscopic Surgery ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Insulin Like Growth Factor ◽

Endoscopic Transsphenoidal Surgery ◽

Factor I ◽

Transsphenoidal Endoscopic Surgery ◽

Growth Factor I

Object Acromegaly is a chronic disease related to the excess of growth hormone (GH) and insulin-like growth factor–I secretion, usually by pituitary adenomas. Traditional treatment of acromegaly consists of surgery, drug therapy, and eventually radiotherapy. The introduction of endoscopy as an additional tool for surgical treatment of pituitary adenomas and, therefore, acromegaly represents an important advance of pituitary surgery in the recent years. The aim of this retrospective study is to evaluate the results of pure transsphenoidal endoscopic surgery in a series of patients with acromegaly who were operated on by a pituitary specialist surgeon. The authors discuss the advantages, outcome, complications, and factors related to the success of the endoscopic approach in cases of GHsecreting adenomas. Methods The authors retrospectively analyzed data from cases involving patients with GH-secreting adenomas who underwent pure transsphenoidal endoscopic surgery at the Department of Neurosurgery of the General Hospital in Fortaleza, Brazil, between 2000 and 2009. Tumors were classified according to size as micro- or macroadenomas, and tumor extension was analyzed based on suprasellar/parasellar extension and sella floor destruction. All patients were followed up for at least 1 year. The criteria of disease control were GH levels < 1 ng/L after oral glucose tolerance test and normal insulin-like growth factor–I levels for age and sex. Results During the study period, 67 patients underwent pure endoscopic transsphenoidal surgery for treatment of acromegaly. Disease control was obtained in 50 cases (74.6%). The rate of treatment success was higher in patients with microadenomas (disease control achieved in 12 [85.7%] of 14 cases) than in those with larger lesions. Suprasellar/parasellar extension and high levels of sella floor erosion were associated with lower rates of disease control (p = 0.01 and p = 0.02, respectively). Complications related to the endoscopic surgery included epistaxis (6.0%), transitory diabetes insipidus (4.5%), and 1 case of seizure (1.5%). Conclusions Endoscopic transsphenoidal surgery represents an effective option for treatment of patients with acromegaly. High disease control rates and a small number of complications are some of the most important points related to the technique. Factors related to the success of the endoscopic surgery are lesion size, suprasellar/parasellar extension, and the degree of sella floor erosion. Although presenting important advantages, there is no conclusive evidence that endoscopy is superior to microsurgery in treatment of GH-secreting adenomas.

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Quantitative evaluation of headache severity before and after endoscopic transsphenoidal surgery for pituitary adenoma

Journal of Neurosurgery ◽

10.3171/2015.5.jns1576 ◽

2016 ◽

Vol 124 (6) ◽

pp. 1627-1633 ◽

Cited By ~ 12

Author(s):

Amparo Wolf ◽

Sandy Goncalves ◽

Fateme Salehi ◽

Jeff Bird ◽

Paul Cooper ◽

...

Keyword(s):

Mental Health ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Short Form ◽

Significant Proportion ◽

Endoscopic Transsphenoidal Surgery ◽

Headache Severity ◽

Younger Age ◽

Sf 36 ◽

The Impact

OBJECT The relationship between headaches, pituitary adenomas, and surgical treatment of pituitary adenomas remains unclear. The authors assessed the severity and predictors of self-reported headaches in patients referred for surgery of pituitary adenomas and evaluated the impact of endoscopic transsphenoidal surgery on headache severity and quality of life (QOL). METHODS In this prospective study, 79 patients with pituitary adenomas underwent endoscopic transsphenoidal resection and completed the Headache Impact Test (HIT-6) and the 36-Item Short Form Health Survey (SF-36) QOL questionnaire preoperatively and at 6 weeks and 6 months postoperatively. RESULTS Preoperatively, 49.4% of patients had mild headache severity, 13.9% had moderate severity, 13.9% had substantial severity, and 22.8% had intense severity. Younger age and hormone-producing tumors predisposed greater headache severity, while tumor volume, suprasellar extension, chiasmal compression, and cavernous sinus invasion of the pituitary tumors did not. Preoperative headache severity was found to be significantly associated with reduced scores across all SF-36 QOL dimensions and most significantly associated with mental health. By 6 months postoperatively, headache severity was reduced in a significant proportion of patients. Of the 40 patients with headaches causing an impact on daily living (moderate, substantial, or intense headache), 70% had improvement of at least 1 category on HIT-6 by 6 months postoperatively, while headache worsened in 7.6% of patients. The best predictors of headache response to surgery included younger age, poor preoperative SF-36 mental health score, and hormone-producing microadenoma. CONCLUSIONS The results of this study confirm that surgery can significantly improve headaches in patients with pituitary adenomas by 6 months postoperatively, particularly in younger patients whose preoperative QOL is impacted. A larger multicenter study is underway to evaluate the long-term effect of surgery on headaches in this patient group.

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Intraoperative Magnetic Resonance Imaging During Endoscopic Transsphenoidal Surgery of Growth Hormone-Secreting Pituitary Adenomas

World Neurosurgery ◽

10.1016/j.wneu.2016.04.094 ◽

2016 ◽

Vol 91 ◽

pp. 490-496 ◽

Cited By ~ 12

Author(s):

David Netuka ◽

Martin Májovský ◽

Václav Masopust ◽

Tomáš Belšán ◽

Josef Marek ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Growth Hormone ◽

Magnetic Resonance ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Resonance Imaging ◽

Endoscopic Transsphenoidal Surgery ◽

Intraoperative Magnetic Resonance Imaging

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NCOG-53. PREDICTORS OF ENDOCRINE OUTCOME AFTER ENDOSCOPIC TRANSSPHENOIDAL SURGERY FOR NON-FUNCTIONING PITUITARY ADENOMAS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.591 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii141-ii141

Author(s):

Jenie Hwang ◽

Diane Yum ◽

Michael Chicoine ◽

Ralph Dacey ◽

Joshua Osbun ◽

...

Keyword(s):

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

De Novo ◽

Postoperative Recovery ◽

Endocrine Function ◽

Male Hypogonadism ◽

Endoscopic Transsphenoidal Surgery ◽

Thyroid Axis ◽

Negative Predictor ◽

New Onset

Abstract BACKGROUND Although endoscopic transsphenoidal surgery (ETSS) is an established treatment for patients with nonfunctioning pituitary adenomas (NFPAs), data are limited regarding the rates and predictors of pituitary dysfunction and recovery in a large cohort of NFPA patients undergoing ETSS. OBJECTIVE To analyze the comprehensive changes in hormonal function and identify factors that predict recovery or worsening of hormonal axes following ETSS for NFPA. METHODS Among a cohort of 601 consecutive patients who underwent ETSS for NFPA between 2010 and 2018 at Washington University in Saint Louis, recovery or development of new hypopituitarism was retrospectively analyzed in 209 patients. RESULTS Preoperative endocrine deficits were observed in 59.8% of patients (125/209), and the deficit rates were 76.8% for male gonadal axis (86/112), 42.5% for thyroid axis, 25.8% for growth hormone axis, and 15.8% for cortisol axis. Recovery of preoperative pituitary deficit was noted in all four axes, with highest recovery in the cortisol axis with a 1-year cumulative recovery rate of 44.3%. New-onset postoperative hypopituitarism occurred most frequently in the thyroid axis (24.3%, 27/111) and least frequently in the cortisol axis (9.7%, 16/165). Multivariate analyses revealed axis-specific predictors of postoperative recovery and de novo deficiency. Older age was a negative predictor for recovery of both male hypogonadism (P= 0.04) and adrenal insufficiency (P=0.046), and a larger tumor volume was a negative predictor for recovery of hypothyroidism (P=0.043). Although higher body mass index was generally associated with any new postoperative pituitary deficit (P=0.03), most predictors of new onset deficits also differed by hormone axis. CONCLUSIONS Dynamic changes in pituitary hormonal levels were observed in a significant fraction of patients following ETSS in NFPA patients. The specific hormonal axis dictated postoperative endocrine vulnerability, recovery, and predictors of recovery or loss of endocrine function.

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