Endoscopic endonasal lateral transellar approach for growth hormone-secreting adenomas with cavernous sinus invasion: Technical note and surgical results

ABSTRACT Objective The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for growth hormone (GH)-secreting adenomas. Methods A retrospective analysis based on medical records of 23 acromegalic patients submitted to endoscopic transsphenoidal surgery. Biochemical control was defined as basal GH < 1ng/ml, nadir GH < 0.4ng/ml after glucose load and age-adjusted IGF-1 normal at the last follow-up. Results The overall endocrinological remission rate was 39.1%. While all microademonas achieved a cure, just one third of macroadenomas went into remission. Suprasellar extension, cavernous sinus invasion and high GH levels were associated with lower rates of disease control. The most common complication was diabetes insipidus and the most severe was an ischemic stroke. Conclusion The endoscopic transsphenoidal approach is a safe and effective technique to control GH-secreting adenomas. The transcavernous approach may increase the risk of complications. Suprasellar and cavernous sinus extensions may preclude gross total resection of these tumors.

Download Full-text

Endoscopic Endonasal Management of Nonfunctioning Pituitary Adenomas with Cavernous Sinus Invasion: Our Experience

Otolaryngology ◽

10.1177/0194599813495815a48 ◽

2013 ◽

Vol 149 (2_suppl) ◽

pp. P48-P48

Author(s):

Fabio Ferreli ◽

Mario Turri-Zanoni ◽

Stefania Gallo ◽

Maurizio Bignami ◽

Giustino Tomei ◽

...

Keyword(s):

Cavernous Sinus ◽

Pituitary Adenomas ◽

Endoscopic Endonasal ◽

Cavernous Sinus Invasion ◽

Nonfunctioning Pituitary Adenomas

Download Full-text

Endoscopic Endonasal Approach to Multilobular Giant Pituitary Adenoma with Cavernous Sinus Invasion and Petroclival Extension

10.1055/s-0041-1725507 ◽

2021 ◽

Author(s):

Tural Rahimli

Keyword(s):

Pituitary Adenoma ◽

Cavernous Sinus ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Giant Pituitary Adenoma ◽

Cavernous Sinus Invasion

Download Full-text

Experience of Endoscopic Endonasal Approach for 803 Pituitary Tumors With Cavernous Sinus Invasion

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000008049 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Haibo Zhu ◽

Chuzhong Li ◽

Songbai Gui ◽

Xinsheng Wang ◽

Xuyi Zong ◽

...

Keyword(s):

Cavernous Sinus ◽

Pituitary Tumors ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Cavernous Sinus Invasion

Download Full-text

Association of different pathologic subtypes of growth hormone producing pituitary adenoma and remission in acromegaly patients: a retrospective cohort study

BMC Endocrine Disorders ◽

10.1186/s12902-021-00850-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Maryam Dehghani ◽

Zahra Davoodi ◽

Farahnaz Bidari ◽

Amin Momeni Moghaddam ◽

Davood Khalili ◽

...

Keyword(s):

Growth Hormone ◽

Cohort Study ◽

Cavernous Sinus ◽

Retrospective Cohort Study ◽

Pituitary Adenomas ◽

Retrospective Cohort ◽

Remission Rate ◽

Cavernous Sinus Invasion ◽

Dual Staining

Abstract Background Regarding the inconclusive results of previous investigations, this study aimed to determine the association between pathology, as a possible predictor, with remission outcomes, to know the role of pathology in the personalized decision making in acromegaly patients. Methods A retrospective cohort study was performed on the consecutive surgeries for growth hormone (GH) producing pituitary adenomas from February 2015 to January 2021. Seventy-one patients were assessed for granulation patterns and prolactin co-expression as dual staining adenomas. The role of pathology and some other predictors on surgical remission was evaluated using logistic regression models. Results Among 71 included patients, 34 (47.9%) patients had densely granulated (DG), 14 (19.7%) had sparsely granulated (SG), 23 (32.4%) had dual staining pituitary adenomas. The remission rate was about 62.5% in the patients with SG and DG adenomas named single staining and 52.2% in dual staining groups. Postoperative remission was 1.53-folds higher in the single staining adenomas than dual staining-one (non-significant). The remission rate was doubled in DG group compared to two other groups (non-significant). By adjusting different predictors, cavernous sinus invasion and one-day postoperative GH levels decreased remission rate by 91% (95% CI: 0.01–0.67; p = 0.015) and 64% (95% CI: 0.19–0.69; p < 0.001), respectively. Responses to the medications were not significantly different among three groups. Conclusion Various pathological subtypes of pituitary adenomas do not appear to have a predictive role in estimating remission outcomes. Cavernous sinus invasion followed by one-day postoperative GH is the strongest parameter to predict biochemical remission.

Download Full-text

Endoscopic endonasal management of non-functioning pituitary adenomas with cavernous sinus invasion: a 10- year experience

Rhinology Journal ◽

10.4193/rhino14.309 ◽

2015 ◽

Vol 53 (4) ◽

pp. 308-316

Author(s):

F. Ferreli ◽

M. Turri-Zanoni ◽

F.R. Canevari ◽

P. Battaglia ◽

M. Bignami ◽

...

Keyword(s):

Cavernous Sinus ◽

Tumor Resection ◽

Mass Effect ◽

Extent Of Resection ◽

Tumor Control ◽

Endoscopic Endonasal ◽

Cavernous Sinus Invasion ◽

Visual Outcomes ◽

Contrast Enhanced ◽

Wait And See

Background: The management of Non-Functioning Pituitary Adenoma (NFPA) invading the cavernous sinus (CS) is currently a balancing act between the surgical decompression of neural structures, radiotherapy and a wait-and-see policy. Methods: We undertook a retrospective review of 56 cases of NFPA with CS invasion treated through an endoscopic endonasal approach (EEA) between 2000 and 2010. The Knosp classification was adopted to describe CS involvement using information from preoperative MRI and intraoperative findings. Extent of resection and surgical outcomes were evaluated on the basis of postoperative contrast-enhanced MRI. Endocrinological improvement and visual outcomes were assessed according to the most recent consensus criteria. Results: EEA was performed using direct para-septal, trans-ethmoidal-sphenoidal or trans-ethmoidal-pterygoidal-sphenoidal approach. Visual outcomes improved in 30 (81%) patients. Normalization or at least improvement of previous hypopituitarism was obtained in 55% of cases. A gross total resection was achieved in 30.3% of cases. The recurrence-free survival was 87.5%, with a mean follow-up of 61 months (range, 36-166 months). No major intraoperative or postoperative complications occurred. Discussion: EEA is a minimally-invasive, safe and effective procedure for the management of NFPA invading the CS. The extent of CS involvement was the main factor limiting the degree of tumor resection. The EEA was able to resolve the mass effect, preserving or restoring visual function, and obtaining adequate long-term tumor control.

Download Full-text

Cavernous sinus invasion and effect of immunohistochemical features over remission in growth hormone secreting pituitary adenomas

Turkish Neurosurgery ◽

10.5137/1019-5149.jtn.9347-13.1 ◽

2014 ◽

Author(s):

Murat Yilmaz ◽

Emin Vural ◽

Kenan Koc ◽

Savas Ceylan

Keyword(s):

Growth Hormone ◽

Cavernous Sinus ◽

Pituitary Adenomas ◽

Cavernous Sinus Invasion

Download Full-text

Causes of Hyperprolactinemia in Acromegalic Patients and Clinical Correlations

Austin Journal of Endocrinology and Diabetes ◽

10.26420/austinjendocrinoldiabetes.2021.1080 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Matos T ◽

◽

Gomes V ◽

Faria C ◽

Gomes A ◽

...

Keyword(s):

Growth Hormone ◽

Cavernous Sinus ◽

Transsphenoidal Surgery ◽

Clinical Course ◽

Course Of Disease ◽

Cavernous Sinus Invasion ◽

Positive Immunostaining ◽

Clinical Correlations ◽

Level Of Significance ◽

Worse Prognosis

Hyperprolactinemia in acromegalic patients may result either from cosecretion of growth hormone and prolactin by the tumour or from pituitary stalk compression. The occurrence of both conditions is possible. This study was designed aiming 1) to estimate the prevalence of each cause of hyperprolactinemia and its respective clinical course; 2) to compare the outcomes of patients with tumours staining only for growth hormone against tumours staining for both growth hormone and prolactin. 75 acromegalic patients submitted to transsphenoidal surgery between 1989 and 2018 were included. Patients were divided based on preoperative prolactin levels and immunostaining pattern. Statistical analysis was performed with SPSS version 23. Hyperprolactinemia was documented in 22 out of 36 patients (61%). Stalk compression was the only underlying cause of hyperprolactinemia in 45% of cases. The levels of prolactin were not associated with the immunostaining pattern for prolactin. Clinical differences were not observed between hyperprolactinemic and normoprolactinemic patients, except for a higher frequency of cavernous sinus invasion (64% vs 29%, p=0,064), that reached the level of significance for the subgroup with macroadenomas staining exclusively for growth hormone (p=0,031). In the present series, no clinical differences were noticed between patients with tumours staining only for growth hormone or staining for both growth hormone and prolactin. Hyperprolactinemia resulting from stalk compression is likely to anticipate a less favourable course of disease, since it is associated with larger tumours and a higher frequency of cavernous sinus invasion. On the contrary, positive immunostaining for prolactin was not a marker of worse prognosis.

Download Full-text