A Benchmark for Preservation of Normal Pituitary Function After Endoscopic Transsphenoidal Surgery for Pituitary Macroadenomas

OBJECTIVELoss of pituitary function due to nonfunctional pituitary adenoma (NFPA) may be due to compression of the pituitary gland. It has been proposed that the size of the gland and relative perioperative gland expansion may relate to recovery of pituitary function, but the extent of this is unclear. This study aims to assess temporal changes in hormonal function after transsphenoidal resection of NFPA and the relationship between gland reexpansion and endocrine recovery.METHODSPatients who underwent endoscopic transsphenoidal surgery by a single surgeon for resection of a nonfunctional macroadenoma were selected for inclusion. Patients with prior pituitary surgery or radiosurgery were excluded. Patient characteristics and endocrine function were extracted by chart review. Volumetric segmentation of the pre- and postoperative (≥ 6 months) pituitary gland was performed using preoperative and long-term postoperative MR images. The relationship between endocrine function over time and clinical attributes, including gland volume, were examined.RESULTSOne hundred sixty eligible patients were identified, of whom 47.5% were female; 56.9% of patients had anterior pituitary hormone deficits preoperatively. The median tumor diameter and gland volume preoperatively were 22.5 mm (interquartile range [IQR] 18.0–28.8 mm) and 0.18 cm3 (IQR 0.13–0.28 cm3), respectively. In 55% of patients, endocrine function normalized or improved in their affected axes by median last clinical follow-up of 24.4 months (IQR 3.2–51.2 months). Older age, male sex, and larger tumor size were associated with likelihood of endocrine recovery. Median time to recovery of any axis was 12.2 months (IQR 2.5–23.9 months); hypothyroidism was the slowest axis to recover. Although the gland significantly reexpanded from preoperatively (0.18 cm3, IQR 0.13–0.28 cm3) to postoperatively (0.33 cm3, IQR 0.23–0.48 cm3; p < 0.001), there was no consistent association with improved endocrine function.CONCLUSIONSRecovery of endocrine function can occur several months and even years after surgery, with more than 50% of patients showing improved or normalized function. Tumor size, and not gland volume, was associated with preserved or recovered endocrine function.

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Residual anterior pituitary function following transsphenoidal resection of pituitary macroadenomas

Journal of Neurosurgery ◽

10.3171/jns.1984.61.3.0577 ◽

1984 ◽

Vol 61 (3) ◽

pp. 577-580 ◽

Cited By ~ 51

Author(s):

Alfred T. Nelson ◽

H. St. George Tucker ◽

Donald P. Becker

Keyword(s):

Anterior Pituitary ◽

Transsphenoidal Surgery ◽

Normal Function ◽

Pituitary Function ◽

Acceptable Risk ◽

Content Type ◽

Anterior Pituitary Function ◽

Improved Function ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

✓ A series of 84 patients with pituitary adenomas greater than 1 cm in diameter is presented. Full preoperative and postoperative endocrine evaluations were carried out, and the effects of transsphenoidal surgery on remaining anterior pituitary function were analyzed. Of the patients who had normal anterior pituitary function before surgery, 78% retained normal function after surgery. Thirty-three percent of those patients with pituitary deficits who did not have panhypopituitarism before surgery had improved function after surgery; 33% had worsened function after surgery. None of the patients with panhypopituitarism before surgery regained function after surgery. Transsphenoidal surgery carries an acceptable risk for sacrificing anterior pituitary function, but the risk is greater in patients with larger tumors and preoperatively compromised pituitary function.

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Effect of Intraoperative Lumbar Drainage on Gross Total Resection and Cerebrospinal Fluid Leak Rates in Endoscopic Transsphenoidal Surgery of Pituitary Macroadenomas

World Neurosurgery ◽

10.1016/j.wneu.2019.12.100 ◽

2020 ◽

Vol 135 ◽

pp. e629-e639 ◽

Cited By ~ 2

Author(s):

Bolin Liu ◽

Yuan Wang ◽

Tao Zheng ◽

Shujuan Liu ◽

Wenhai Lv ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Transsphenoidal Surgery ◽

Cerebrospinal Fluid Leak ◽

Gross Total Resection ◽

Total Resection ◽

Endoscopic Transsphenoidal Surgery ◽

Lumbar Drainage ◽

Fluid Leak ◽

Pituitary Macroadenomas

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Retrospective analysis of a concurrent series of microscopic versus endoscopic transsphenoidal surgeries for Knosp Grades 0–2 nonfunctioning pituitary macroadenomas at a single institution

Journal of Neurosurgery ◽

10.3171/2014.6.jns131321 ◽

2014 ◽

Vol 121 (3) ◽

pp. 511-517 ◽

Cited By ~ 48

Author(s):

Robert Dallapiazza ◽

Aaron E. Bond ◽

Yuval Grober ◽

Robert G. Louis ◽

Spencer C. Payne ◽

...

Keyword(s):

Retrospective Analysis ◽

Transsphenoidal Surgery ◽

Eligible Patient ◽

Residual Tumor ◽

Single Institution ◽

Endoscopic Transsphenoidal Surgery ◽

Csf Rhinorrhea ◽

Endoscopic Group ◽

Pituitary Macroadenomas

Object The object of this study was to compare surgical outcomes and complications in a contemporaneous series of patients undergoing either microscopic or endoscopic transsphenoidal surgery for nonfunctioning pituitary macroadenomas without imaging evidence of cavernous sinus invasion. Methods This is a retrospective analysis of a prospectively collected database from a single institution. Data were collected from patients whose surgery had occurred in the period from June 2010 to January 2013. Patients who underwent microscopic or endoscopic surgery for Knosp Grade 0, 1, or 2 nonfunctioning pituitary macroadenomas were included in the study. Patients who had clinically secreting or Knosp Grade 3 or 4 tumors and patients who were undergoing revision surgery were excluded from analysis. Eligible patient records were analyzed for outcomes and complications. Statistical analyses were performed on tumor volume, intraoperative factors, postoperative complications, and degree of resection on 1-year postoperative MRI. The results were used to compare the outcomes after microscopic and endoscopic approaches. Results Forty-three patients underwent microscopic transsphenoidal surgery, and 56 underwent endoscopic transsphenoidal surgery. There were no statistical differences in the intraoperative extent of resection or endocrinological complications. There were significantly more intraoperative CSF leaks in the endoscopic group (58% vs 16%); however, there was no difference in the incidence of postoperative CSF rhinorrhea (12% microscopic vs 7% endoscopic). Length of hospitalization was significantly shorter in patients undergoing an endoscopic approach (3.0 days vs 2.4 days). Two-month follow-up imaging was available in 95% of patients, and 75% of patients had 1-year follow-up imaging. At 2 months postprocedure, there was no evidence of residual tumor in 79% (31 of 39) and 85% (47 of 55) of patients in the microscopic and endoscopic groups, respectively. At 1 year postprocedure, 83% (25 of 30) of patients in the microscopic group had no evidence of residual tumor and 82% (36 of 44) of those in the endoscopic group had no evidence of residual tumor. Conclusions The microscopic and endoscopic techniques provide similar outcomes in the surgical treatment of Knosp Grades 0–2 nonfunctioning pituitary macroadenomas.

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