Complication Rates after Endoscopic Transsphenoidal Surgery for ACTH-Secreting Pituitary Adenomas: A Comparative Analysis with GH and Nonfunctioning Adenomas

2021 ◽  
Author(s):  
Juan Á. Aibar-Durán ◽  
Michael Oladotun-Anka ◽  
Carlos Asencio-Cortés ◽  
Elena Valassi ◽  
Susan Webb ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Statistical Analysis ◽  
Diabetes Insipidus ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Csf Leak ◽  
Complication Rates ◽  
Endoscopic Transsphenoidal Surgery ◽  
Number Of Patients ◽  
Acth Secreting

Abstract Objectives Some complications have been more frequently reported after surgery for adrenocorticotropin hormone (ACTH)-secreting pituitary adenomas. We compared complication rates in patients with ACTH-secreting pituitary adenomas with those in patients with growth hormone secreting pituitary adenomas (growth hormone [GH] group) and nonfunctioning adenomas (nonfunctioning group). Design A comparative three-group analysis was performed for all patients who had endoscopic transsphenoidal surgery for pituitary adenomas at our center between January 2011 and May 2019. Variables included demographics, preoperative clinical and radiological characteristics, and postoperative radiological and endocrinological outcomes. Complications were divided into four categories: endocrinological, neurosurgical, medical, and ENT (ear–nose–throat)-related complications. Univariate and multivariate statistical analysis were performed. Results A total of 111 patients with pituitary adenomas and a mean age of 53.7 years were included (25 ACTH, 35 GH, and 51 nonfunctioning adenomas). Overall, 28 patients had microadenomas (25.2%) and 83 had macroadenomas (74.8%). Univariate statistical analysis for complications between groups showed no differences in neurosurgical and medical complications. Transient diabetes insipidus and postsurgical bacterial sinusitis were the only variables more frequently seen in the ACTH group (p = 0.01 and 0.04, respectively). Multivariate analysis for transient diabetes insipidus showed no differences between groups (p = 0.58). Conclusion Complication rates were similar in all three adenoma groups, particularly concerning major infections, thrombotic events, postoperative cerebrospinal fluid (CSF) leak, and transient diabetes insipidus. Transient diabetes insipidus was related with adenoma size and intraoperative CSF leak. Despite postoperative bacterial sinusitis was statistically higher in the ACTH group, this data should be interpreted with caution given the low number of patients with this complication.

Transsphenoidal Endoscopic versus Microscopic Approach in Treatment of Pituitary Adenomas: CSF Leak and GTR Systematic review

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ibrahim M Omran ◽  
Hamdy Ibrahim ◽  
Emad Maamon ◽  
Ahmed Yousry
Keyword(s):  
Brain Tumors ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Csf Leak ◽  
Endoscopic Transsphenoidal Surgery ◽  
Microscopic Surgery ◽  
Cochrane Database ◽  
Number Of Patients ◽  
Significant Difference ◽  
Endoscopic Group

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.

scholarly journals Influence of Variables on Hormone Profile in Endoscopic Transsphenoidal Surgery for Pituitary Adenomas

2019 ◽  
Vol 29 (3) ◽  
pp. 508-516
Author(s):  
Fernando Simões Nazareno ◽  
Rodrigo Alves de Carvalho Cavalcante ◽  
Tiago Vinicius Silva Fernandes ◽  
Osvaldo Vilela Garcia Filho
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Medical Records ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Total Population ◽  
Transsphenoidal Approach ◽  
Endoscopic Transsphenoidal Surgery ◽  
Grade Method ◽  
Hormone Profile

Objective: to evaluate the hormone profiles of patients with pituitary adenomas operated on in Hospital das Clínicas, UniversidadeFederal de Goiás (HC-UFG), correlating them with the variables age, sex, and Knosp grade. Method: This is a retrospective quantitativestudy of medical records, including a total population of 20 patients diagnosed with pituitary adenomas operated on using the pureendoscopic endonasal transsphenoidal approach. The hormone profiles of the three types of pituitary adenoma prevalent in this institutionwere analyzed: nonfunctioning macroadenoma, growth hormone-secreting pituitary adenoma (acromegaly), and adrenocorticotropichormone-secreting pituitary adenoma (Cushing’s disease). Pre and postoperative hormone values were statistically paired with thevariables selected. Results: The global levels of the specific hormones of each disease decreased after surgery. However, no statisticalsignificance was found between the variables selected in this study and the pre and postoperative hormone values. Conclusion:The main surgical goal, the specific hormones decrease, was achieved in all the surgeries performed. Analyzing the relationshipbetween the variables and the hormone profiles, we conclude that age, sex, and Knosp grade did not influence the results obtained.

Endoscopic endonasal transsphenoidal approach for pituitary adenomas invading the cavernous sinus

2010 ◽  
Vol 112 (1) ◽  
pp. 99-107 ◽  
Author(s):  
Savas Ceylan ◽  
Kenan Koc ◽  
Ihsan Anik
Keyword(s):  
Growth Hormone ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Adrenocorticotropic Hormone ◽  
Multidisciplinary Treatment ◽  
Transsphenoidal Approach ◽  
Endoscopic Transsphenoidal Surgery ◽  
Endoscopic Endonasal ◽  
Sinus Wall

Object In this report, the authors describe their experience with surgical access to the cavernous sinus via a fully transnasal endoscopic approach in 20 cases. Clinical and endocrinological follow-up are discussed. Methods The authors used an endoscopic transsphenoidal approach in 192 patients with pituitary adenomas between September 1997 and January 2008, adding a cavernous sinus approach in 20 patients with invasive tumors during the last 5 years of this period. Parasellar extension of the tumor was measured according to the Knosp Scale. Radical tumor removal was achieved in 13 (65%) of 20 patients, and subtotal removal in 7 (35%). The authors used recently defined cavernous sinus approaches in the first 14 cases, including the paraseptal approach in 6, middle turbinectomy in 7, and contralateral middle turbinectomy in 1 case. Combined approaches rather than defined standard cavernous sinus approaches were used in 4 cases and an extended approach in 2. Results The tumors included nonsecretory adenomas in 5 cases (25%), growth hormone–secreting adenomas in 7 (35%), prolactin-secreting adenomas in 4 (20%), and adrenocorticotropic hormone–secreting adenomas in 4 cases (20%). Normal growth hormone and insulin-like growth factor 1 levels were achieved in 4 patients (57%) with growth hormone adenomas, and remission criteria were obtained in 3 patients with prolactinomas and 3 patients with adrenocorticotropic hormone–secreting adenomas. Conclusions Compared with transcranial and microscopic transsphenoidal surgery, endoscopic transsphenoidal surgery offers a wide exposure for cavernous sinus medial wall adenomas that enables removal of the adenoma from the medial cavernous sinus wall. Because of the necessity for multidisciplinary treatment to achieve satisfactory results, Gamma Knife surgery and medical therapy should be supplementary treatment options after endoscopic transsphenoidal surgery.

scholarly journals Outcomes of endoscopic transsphenoidal surgery for Cushing's disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zarina Brady ◽  
Aoife Garrahy ◽  
Claire Carthy ◽  
Michael W. O’Reilly ◽  
Christopher J. Thompson ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Remission Rate ◽  
Cushing's Disease ◽  
Endoscopic Transsphenoidal Surgery ◽  
Endocrine Society ◽  
Csf Leakage ◽  
Remission Rates

Abstract Background Transsphenoidal surgery (TSS) to resect an adrenocorticotropic hormone (ACTH)-secreting pituitary adenoma is the first-line treatment for Cushing’s disease (CD), with increasing usage of endoscopic transsphenoidal (ETSS) technique. The aim of this study was to assess remission rates and postoperative complications following ETSS for CD. Methods A retrospective analysis of a prospective single-surgeon database of consecutive patients with CD who underwent ETSS between January 2012–February 2020. Post-operative remission was defined, according to Endocrine Society Guidelines, as a morning serum cortisol < 138 nmol/L within 7 days of surgery, with improvement in clinical features of hypercortisolism. A strict cut-off of < 50 nmol/L at day 3 post-op was also applied, to allow early identification of remission. Results A single surgeon (MJ) performed 43 ETSS in 39 patients. Pre-operative MRI localised an adenoma in 22 (56%) patients; 18 microadenoma and 4 macroadenoma (2 with cavernous sinus invasion). IPSS was carried out in 33 (85%) patients. The remission rates for initial surgery were 87% using standard criteria, 58% using the strict criteria (day 3 cortisol < 50 nmol/L). Three patients had an early repeat ETSS for persistent disease (day 3 cortisol 306-555 nmol/L). When the outcome of repeat early ETSS was included, the remission rate was 92% (36/39) overall. Remission rate was 94% (33/35) when patients with macroadenomas were excluded. There were no cases of CSF leakage, meningitis, vascular injury or visual deterioration. Transient and permanent diabetes insipidus occurred in 33 and 23% following first ETSS, respectively. There was one case of recurrence of CD during the follow-up period of 24 (4–79) months. Conclusion Endoscopic transsphenoidal surgery produces satisfactory remission rates for the primary treatment of CD, with higher remission rates for microadenomas. A longer follow-up period is required to assess recurrence rates. Patients should be counselled regarding risk of postoperative diabetes insipidus.

Outcomes after a purely endoscopic transsphenoidal resection of growth hormone–secreting pituitary adenomas

2010 ◽  
Vol 29 (4) ◽  
pp. E5 ◽  
Author(s):  
Peter G. Campbell ◽  
Erin Kenning ◽  
David W. Andrews ◽  
Sanjay Yadla ◽  
Marc Rosen ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenomas ◽  
Remission Rate ◽  
Csf Leak ◽  
Oral Glucose ◽  
Cure Rate ◽  
Cavernous Sinus Invasion ◽  
Remission Criteria ◽  
Biochemical Cure ◽  
Transsphenoidal Resection

Object Using strict biochemical remission criteria, the authors assessed surgical outcomes after endoscopic transsphenoidal resection of growth hormone (GH)–secreting pituitary adenomas and identified preoperative factors that significantly influence the rate of remission. Methods A retrospective review of a prospectively maintained database was performed. The authors reviewed cases in which an endoscopic resection of GH-secreting pituitary adenomas was performed. The cohort consisted of 26 patients who had been followed for 3–60 months (mean 24.5 months). The thresholds of an age-appropriate, normalized insulin-like growth factor–I concentration, a nadir GH level after oral glucose load of less than 1.0 μg/l, and a random GH value of less than 2.5 μg/l were required to establish biochemical cure postoperatively. Results Overall, in 57.7% of patients undergoing a purely endoscopic transsphenoidal pituitary adenectomy for acromegaly, an endocrinological cure was achieved. The mean clinical follow-up duration was 24.5 months. In patients with microadenomas (4 cases) the cure rate was 75%, whereas in patients harboring macroadenomas (22 cases) the cure rate was 54.5%. Cavernous sinus invasion (Knosp Grades 3 and 4) was associated with a significantly lower remission rate (p = 0.0068). Hardy Grade 3 and 4 tumors were also less likely to achieve biochemical cure (p = 0.013). The overall complication rate was 11.5% including 2 incidents of transient diabetes insipidus and 1 postoperative CSF leak, which were treated nonoperatively. Conclusions A purely endoscopic transsphenoidal approach to GH-secreting pituitary adenomas leads to similar outcome for noninvasive macroadenomas compared with traditional microsurgical techniques. Furthermore, this approach may often provide maximal visualization of the tumor, the pituitary gland, and the surrounding neurovascular structures.

Bevacizumab in Aggressive Pituitary Adenomas – Experience with 3 Patients

2020 ◽  
Author(s):  
Katharina Osterhage ◽  
Roman Rotermund ◽  
Michael Droste ◽  
Judith Dierlamm ◽  
Wolfgang Saeger ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Pituitary Tumors ◽  
Considerable Effect ◽  
General Statement ◽  
Patient Deterioration ◽  
Short Period ◽  
Acth Secreting ◽  
Design And Methods ◽  
Current Stage

Abstract Objective To investigate bevacizumab as alternative treatment of aggressive pituitary adenomas after exhaustion of standard therapies. Design and Methods Retrospectively, 3 patients undergoing microscopic transsphenoidal surgery of aggressive pituitary adenomas from 2008 till 2018 that were treated with bevacizumab were identified. Development of disease and treatment were evaluated. Results Two patients suffered from ACTH-secreting adenomas, one from a non-functioning adenoma. All patients underwent multiple surgical, chemo- and radiotherapeutical approaches including temozolomide, showing favorable results in one patient. Deterioration of clinical condition in all patients led to an individual, palliative attempt of bevacizumab. Patients 1 and 2 showed a decrease of ACTH after first administrations, but therapy had to be ended shortly after due to a further deterioration of their condition. Patient 3 showed a stabilization of the disease for 18 months. Patients died 8, 15 and 7 years after initial diagnosis, respectively, and 2, 4, and 24 months after initiation of bevacizumab therapy, respectively. Conclusion The demonstrated results suggest a considerable effect of bevacizumab in aggressive pituitary adenomas. The advanced stage of disease in all three patients, the overall short period of administration and just one patient showing a clinical benefit do not allow a general statement on the effectiveness. At the current stage of clinical experience, an approach with bevacizumab can be considered as an individual palliative attempt of treatment, when standard treatments are exhausted. Our results underline the need for further studies to evaluate this drug as potential player in therapy resistant aggressive pituitary tumors.

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