scholarly journals Surgical management of tentorial meningiomas: case series

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Hussein Mohammed Soffar ◽  
Mohamed Mohsen El Shimy ◽  
Hieder Al-Shami ◽  
Ahmed M. Salah
Keyword(s):  
Case Series ◽  
Extent Of Resection ◽  
Glasgow Outcome Score ◽  
Subtotal Resection ◽  
Total Removal ◽  
Surgical Strategies ◽  
Simpson Grade ◽  
Tentorial Meningioma ◽  
Outcome Score ◽  
Subtotal Removal

Abstract Background There are several surgical strategies involved in the treatment of patients with tentorial meningioma, and choosing the most appropriate one is not straight forward. Our study aims to illustrate our experience in the management of tentorial meningiomata at our center. Results This study included 32 patients with tentorial meningiomas, operated upon, with assessment of the extent of resection and the Glasgow outcome score (GOS). The mean age at the time of surgery for the studied group was 48.4 years ranging from 20 to 70 years. Total removal was considered as Simpson grade I or II and was achieved in 26 cases (81.25%). Subtotal removal was considered as Simpson grade III or IV and was achieved in 6 cases (18.75%). The final Glasgow outcome score (GOS) for all cases was GOS 1 in 4 cases (12.5%), GOS 4 in 9 cases (28.2%), and GOS 5 in 19 cases (59.3%). Conclusion Tentorial meningiomas can be very challenging during surgery due to their proximity to vital structures. Subtotal resection should be considered when total removal can be hazardous to the patient or result in severe morbidity.

Is Falcine Meningioma a Diffuse Disease of the Falx? Case Series and Analysis of a “Grade Zero” Resection

Neurosurgery ◽  
2020 ◽  
Vol 87 (5) ◽  
pp. 900-909 ◽  
Author(s):  
Michael A Mooney ◽  
Mohammad Abolfotoh ◽  
Wenya Linda Bi ◽  
Daryoush Tavanaiepour ◽  
Rami O Almefty ◽  
...  
Keyword(s):  
De Novo ◽  
Statistical Significance ◽  
Case Series ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Senior Author ◽  
Subtotal Resection ◽  
Simpson Grade ◽  
The Impact ◽  
Falcine Meningioma

Abstract BACKGROUND Falcine meningiomas have unique characteristics including their high rates of recurrence, association with high grade pathology, increased male prevalence, and potential for diffuse involvement of the falx. OBJECTIVE To address these issues in a substantial series of falcine meningiomas and report on the impact of extent of resection for this distinct meningioma entity. METHODS Retrospective analysis of characteristics and outcomes of 59 falcine meningioma patients who underwent surgery with the senior author. A “Grade Zero” category was used when an additional resection margin of 2 to 3 cm from the tumor insertion was achieved. RESULTS For de novo falcine meningiomas, gross total resection (GTR) was associated with significantly decreased recurrence incidence compared with subtotal resection (P ≤ .0001). For recurrent falcine meningiomas, median progression-free survival (PFS) was significantly improved for GTR cases (37 mo vs 12 mo; P = .017, hazard ratio (HR) .243 (.077-.774)). “Grade Zero” resection demonstrated excellent durability for both de novo and recurrent cases, and PFS was significantly improved with “Grade Zero” resection for recurrent cases (P = .003, HR 1.544 (1.156-2.062)). The PFS benefit of “Grade Zero” resection did not achieve statistical significance over Simpson grade 1 during the limited follow-up period (mean 2.8 yr) for these groups. CONCLUSION The recurrence of falcine meningiomas is related to the diffuse presence of tumor between the leaflets of the falx. Increased extent of resection including, when possible, a clear margin of falx surrounding the tumor base was associated with the best long-term outcomes in our series, particularly for recurrent tumors.

scholarly journals Microneurosurgical aspects in the management of posterior cranial fossa epidermoids: experience of 24 cases

2020 ◽  
Vol 8 (2) ◽  
pp. 606
Author(s):  
V. V. Ramesh Chandra ◽  
B. C. M. Prasad ◽  
V. Niranjan ◽  
Paradesi Rajesh
Keyword(s):  
Extent Of Resection ◽  
Posterior Cranial Fossa ◽  
Subtotal Resection ◽  
Total Removal ◽  
Cranial Nerve Dysfunction ◽  
Significant Difference ◽  
Institutional Experience ◽  
Cranial Fossa ◽  
The Mean ◽  
Subtotal Removal

Background: There is considerable debate in the surgical management of epidermoid cyst, whether gross total or subtotal resection yields better long term outcomes. We present our institutional experience in evaluating the clinical presentation, diagnosis, and surgical strategy and extent of resection in the management of posterior cranial fossa epidermoid cyst.Methods: A retrospective review of 24 patients diagnosed with posterior cranial fossa epidermoid tumors surgically treated at the institution between January 2010 and July 2019.Results: A total of 24 patients who underwent surgery for intracranial epidermoid lesions were identified. Of these 13 were in the Cerebellopontine angle region, eight were in the fourth ventricle, and three in lateral cerebellar convexity. The mean duration from onset of symptoms to surgery was 1.6 years. Cranial nerve dysfunction was noted in 73% of patients preoperatively, most of them being the CPA epidermoids. Total removal was achieved in 16 patients, near-total resection in 6 patients, and subtotal removal in 2 patients. Three patients developed recurrence radiologically of them only one patient became symptomatic. The mean duration of follow-up was 3.8 years. The content of the tumor was pearly white material in all cases. Complications noted in the present series were not related to the completeness of excision. Mortality was noted in one patient.Conclusions: The present study highlights various precautions to be taken intraoperatively in the prevention of development of aseptic meningitis and concludes that total removal of epidermoids does not result in significantly increased morbidity and mortality and should be the goal of surgical treatment. However, near/subtotal resection of lesions that are densely adherent to neurovascular structures is justified, as there is no significant difference in the rate of recurrence. An endoscope can be used to assess the completeness of surgery.

Individualized surgical strategies for Rathke cleft cyst based on cyst location

2013 ◽  
Vol 119 (6) ◽  
pp. 1437-1446 ◽  
Author(s):  
Jun Fan ◽  
Yuping Peng ◽  
Songtao Qi ◽  
Xi-an Zhang ◽  
Binghui Qiu ◽  
...  
Keyword(s):  
Extent Of Resection ◽  
Gross Total Resection ◽  
Surgical Approaches ◽  
Subtotal Resection ◽  
Total Resection ◽  
Surgical Strategies ◽  
Minimal Invasiveness ◽  
Rathke Cleft Cyst ◽  
Csf Leakage ◽  
Keyhole Craniotomy

Object An assessment regarding both surgical approaches and the extent of resection for Rathke cleft cysts (RCCs) based on their locations has not been reported. The aim of this study was to report the results of a large series of surgically treated patients with RCCs and to evaluate the feasibility of individualized surgical strategies for different RCCs. Methods We retrospectively reviewed 87 cases involving patients with RCCs (16 intrasellar, 50 intra- and suprasellar, and 21 purely suprasellar lesions). Forty-nine patients were treated via a transsphenoidal (TS) approach, and 38 were treated via a transcranial (TC) approach (traditional craniotomy in 21 cases and supraorbital keyhole craniotomy in 17). The extent of resection was classified as gross-total resection (GTR) or subtotal resection (STR) of the cyst wall. Patients were thus divided into 3 groups according to the approach selected and the extent of resection: TS/STR (n = 49), TC/STR (n = 23), and TC/GTR (n = 15). Results Preoperative headaches, visual dysfunction, hypopituitarism, and diabetes insipidus (DI) resolved in 85%, 95%, 55%, and 65% of patients, respectively. These rates did not differ significantly among the 3 groups. Overall, complications occurred in 8% of patients in TS/STR group, 9% in TC/STR group, and 47% in TC/GTR group, respectively (p = 0.002). Cerebrospinal fluid (CSF) leakage (3%), new hypopituitarism (9%), and DI (6%) were observed after surgery. All CSF leaks occurred in the endonasal group, while the TC/GTR group showed a higher rate of postoperative hypopituitarism (p = 0.7 and p < 0.001, respectively). It should be particularly noted that preoperative hypopituitarism and DI returned to normal, respectively, in 100% and 83% of patients who underwent supraorbital surgery, and with the exception of 1 patient who had transient postoperative DI, there were no complications in patients treated with supraorbital surgery. Kaplan-Meier 3-year recurrence-free rates were 84%, 87%, and 86% in the TS/STR, TC/STR, and TC/GTR groups, respectively (p = 0.9). Conclusions It is reasonable to adopt individualized surgical strategies for RCCs based on cyst location. Gross-total resection does not appear to reduce the recurrence rate but increase the risk of postoperative complications. The endonasal approach seems more appropriate for primarily intrasellar RCCs, while the craniotomy is recommended for purely or mainly suprasellar cysts. The supraorbital route appears to be preferred over traditional craniotomy for its minimal invasiveness and favorable outcomes. The endoscopic technique is helpful for either endonasal or supraorbital surgery.

Surgical Management of Anterolateral and Posteromedial Incisural Tentorial Meningioma

2017 ◽  
Vol 15 (2) ◽  
pp. 120-130 ◽  
Author(s):  
Andrea Talacchi ◽  
Antonio Biroli ◽  
Stefano Medaglia ◽  
Francesca Locatelli ◽  
Mario Meglio
Keyword(s):  
Residual Tumor ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Surgical Approaches ◽  
Clinical Aspects ◽  
Incomplete Resection ◽  
Simpson Grade ◽  
Tentorial Meningioma ◽  
Deep Site

Abstract BACKGROUND Tentorial meningiomas are a broad and consistent category of tumors but their definition is still unclear and their classification uncertain. OBJECTIVE To report the clinical and surgical characteristics of tentorial hiatus meningiomas based on a revised classification of tentorial meningiomas. METHODS We reviewed the records of 14 patients who had undergone microsurgical removal of incisural tentorial meningioma. Two tumor subgroups, anterolateral (AL) and posteromedial (PM), were distinguished according to their site of attachment: the middle third and the posterior third of the tentorial free margin, respectively. Clinical presentation, radiological findings, surgical approaches, extent of resection, and outcome were compared. RESULTS The 2 subgroups differed by tumor size (larger in PM), incidence of the direction of growth (infratentorial in PM), and hydrocephalus (only in PM), as well as by some clinical aspects. Surgical approach depended on tumor location: lateral (pterional, subtemporal, and retromastoid) for AL lesions; medial (occipital or supracerebellar infratentorial) for PM lesions. Total removal (Simpson grade I-II) was performed in 64% of cases and complications occurred in 14%. Stereotactic radiosurgery was performed in cases of incomplete resection. At a mean follow-up of 104.5 mo, clinical improvement with low recurrence (9%) was achieved. CONCLUSION Reallocation of tentorial edge meningiomas is the premise to compare treatment and further improve the approach case-by-case. In spite of their deep site, good outcomes can be achieved in both AL and PM tentorial meningiomas. Also of note is the indolent behavior of residual tumor.

scholarly journals Grade III meningioma: 10 year single centre case series

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv18-iv18
Author(s):  
Hari Mcgrath ◽  
Jose Lavrador ◽  
Ioannis Christodoulides ◽  
Prajwal Ghimire ◽  
Richard Gullan ◽  
...  
Keyword(s):  
Case Series ◽  
Extent Of Resection ◽  
Tumour Recurrence ◽  
Subtotal Resection ◽  
Who Grade ◽  
Surgical Interventions ◽  
Grade 3 ◽  
Oncology Centre ◽  
Rhabdoid Features

Abstract Rationale WHO Grade 3 meningiomas are a rare, malignant subtype of meningioma. Few controlled case series detailing its treatment and follow-up are to be found in the literature. Methods Retrospective cohort study of patients treated in a single neuro-oncology centre in the period between September 2008 and March 2019 with an initial diagnosis of WHO Grade 3 meningioma. Demographic and clinical data has been collected from the available medical records. Results 9 patients were included in this series: 2 had convexity, 2 sphenoid wing, 2 parafalcine, 1 parasagittal with a further 3 multiple locations and 1 patient with parietal convexity meningioma. 3 tumours displayed rhabdoid features, whilst 4 displayed papillary features and a further 2 displayed epithelial structures. All patients underwent surgical intervention: 5 patients had a subtotal resection with 3 having total resection. 3/4 of reported Simpson Grading was grade 2, whilst the remaining 1/4 was grade 1. The extent of resection for 1 patient was uncertain. Post surgically, 6 received adjuvant radiotherapy, 2 had no further treatment and 1 received gamma knife therapy. No patient received chemotherapy. 5 patients saw no tumour recurrence at follow up appointments (mean 50 months). Within 2 years of their respective surgical interventions, 4 patients died due to tumour recurrence and associated complications (3 patients). Conclusion To establish a uniform approach to treatment of patients with WHO Grade 3 meningiomas is challenging. Management involves a patient-centred approach based on multidisciplinary meeting decisions. Multicentre registries may allow further conclusions.

Intracranial Papillary Meningioma

Neurosurgery ◽  
2013 ◽  
Vol 73 (5) ◽  
pp. 777-790 ◽  
Author(s):  
Xiao-Qiang Wang ◽  
Hong Chen ◽  
Lin Zhao ◽  
Shi-Ting Li ◽  
Jie Hu ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Clinical Characteristics ◽  
Postoperative Radiotherapy ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Total Removal ◽  
Free Survival ◽  
Papillary Meningioma ◽  
Subtotal Removal

Abstract BACKGROUND: Papillary meningioma (PM) is an uncommon meningioma subtype, and the clinical characteristics remain unclear. OBJECTIVE: To determine the clinical characteristics and prognosis of PM. METHODS: The clinical data of 30 PM patients were collected, the samples were reexamined, and the patients' prognoses were based on clinical observations and calculated according to the Kaplan-Meier method. RESULTS: The 30 patients included 16 males and 14 females (median: 34.0 years upon initial diagnosis). Of the 48 intracranial operations in the 30 patients, total removal was attained in 34 surgeries, and subtotal removal in 14 surgeries. Radiotherapy was provided in 20 patients. In 40 specimens with follow-up, 29 attained the positive aggressive factors. Six tumors showed positive progestogen receptor (PR) combined with negative Bcl-2. The median follow-up period was 39.0 months. Tumor recurrence occurred in 18 patients (median: 17.0 months); the recurrence rates following total removal and subtotal removal were 57.1% and 100%, respectively. Fourteen patients died of the recurrence. In the univariate analyses, positive aggressive factors (P = .021), positive PR combined with negative Bcl-2 immunoreactivity (P = .011), the extent of resection (P = .001), and radiotherapy (P = .002) were significantly related to progression-free survival. The MIB-1 labeling index was not significantly related to progression-free survival (P = .88). CONCLUSION: PM is a rare subtype of meningioma with a tendency of recurrence. The extent of resection is an important prognosis factor. The presence of positive histopathological index increases the recurrence risk. Positive PR combined with negative Bcl-2 immunoreaction might predict a good prognosis. Postoperative radiotherapy may play a vital role in prolonging the time to tumor recurrence.

scholarly journals Adult Craniopharyngioma: Case Series, Systematic Review, and Meta-Analysis

Neurosurgery ◽  
2017 ◽  
Vol 83 (4) ◽  
pp. 631-641 ◽  
Author(s):  
Charlotte Dandurand ◽  
Amir Ali Sepehry ◽  
Mohammad Hossein Asadi Lari ◽  
Ryojo Akagami ◽  
Peter Gooderham
Keyword(s):  
Systematic Review ◽  
Adjuvant Radiotherapy ◽  
Meta Analysis ◽  
Case Series ◽  
Extent Of Resection ◽  
Treatment Modalities ◽  
Future Research ◽  
Subtotal Resection ◽  
Risk Of Recurrence ◽  
Institutional Experience

Abstract BACKGROUND The optimal therapeutic approach for adult craniopharyngioma remains controversial. Some advocate for gross total resection (GTR), while others advocate for subtotal resection followed by adjuvant radiotherapy (STR + XRT). OBJECTIVE To conduct a systematic review and meta-analysis assessing the rate of recurrence in the follow-up of 3 yr in adult craniopharyngioma stratified by extent of resection and presence of adjuvant radiotherapy. METHODS MEDLINE (1946-July 1, 2016) and EMBASE (1980-June 30, 2016) were systematically reviewed. From1975 to 2013, 33 patients were treated with initial surgical resection for adult onset craniopharyngioma at our center and were reviewed for inclusion in this study. RESULTS Data from 22 patients were available for inclusion as a case series in the systematic review. Eligible studies (n = 21) were identified from the literature in addition to a case series of our institutional experience. Three groups were available for analysis: GTR, STR + XRT, and STR. The rates of recurrence were 17%, 27%, and 45%, respectively. The risk of developing recurrence was significant for GTR vs STR (odds ratio [OR]: 0.24, 95% confidence interval [CI]: 0.15-0.38) and STR + XRT vs STR (OR: 0.20, 95% CI: 0.10-0.41). Risk of recurrence after GTR vs STR + XRT did not reach significance (OR: 0.63, 95% CI: 0.33-1.24, P = .18). CONCLUSION This is the first and largest systematic review focusing on the rate of recurrence in adult craniopharyngioma. Although the rates of recurrence are favoring GTR, difference in risk of recurrence did not reach significance. This study provides guidance to clinicians and directions for future research with the need to stratify outcomes per treatment modalities.

Prognostic factors and outcome of atypical and anaplastic meningioma with and without radiation.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 2083-2083
Author(s):  
Hannah Yoon ◽  
Irene B. Helenowski ◽  
Karthikeyan Perumal ◽  
MaryAnne H. Marymont ◽  
James Chandler ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
External Beam Radiation ◽  
Subtotal Resection ◽  
Beam Radiation ◽  
Brain Invasion ◽  
Simpson Grade

2083 Background: We evaluated outcome and prognostic factors for high grade meningioma (G2-3) and the role of early post-operative radiotherapy (RT). Methods: From 2000 to 2010, 136 patients were diagnosed with G2-3 meningioma at Northwestern: 124 with atypical (G2) and 12 with anaplastic (G3) meningioma. All were treated with or without RT after initial or subsequent resection. The primary endpoint was progression-free survival (PFS). Results: 21 patients received adjuvant RT, and 115 did not. Median PFS for G2 with and without RT was 68 vs.89 mos. Median PFS for G3 with and without RT was not reached=nr (mean 5) vs.60 mos (mean 35). Median PFS for Simpson G1-3 with and without RT was 18 vs.96 mos. Median PFS for Simpson G4 with and without RT was nr (mean 55) vs.59 mos (mean 44). For median follow-up of 33 mos for Simpson G1-3 and 29 mos for G4, recurrence rate for Simpson G1-3 with and without RT was 40 vs.6%, and for Simpson G4 with and without RT, 9 vs.31%. 3-yr OS for G2 with and without RT was 93 vs.94%. 3-yr OS for G3 with and without RT was 80 vs.80%. In multivariate analysis, G3 histology and Simpson grade were predictive for relapse, while brain invasion, mitoses, adjuvant RT, and location of tumor were not. For those who received adjuvant RT, mean dose of external beam radiation (EBRT) in 2 patients was 58 Gy, while mean dose of stereotactic radiosurgery (SRS) in 15 patients was 15 Gy. 51% EBRT patients recurred, while 22% SRS patients recurred (p = 0.45). Median PFS with EBRT was 43 vs.51 mos for SRS (p = 0.34). Patients were maldistributed between the with and without RT arms in terms of brain invasion, extent of resection, and G3 histology. Conclusions: Patients who received RT had lower PFS compared to those who did not; survival was comparable. This may be due to inherent selection bias for patients with more aggressive disease getting adjuvant RT. Our study may be underpowered to determine the true role of RT in G2-3 meningioma. Patients with subtotal resection, Simpson G4, who received RT had fewer recurrences and higher PFS compared to those who did not. 3-yr OS was equivalent in both G2 and G3 tumors with and without RT. G3 histology and Simpson grade were predictive for relapse while brain invasion, mitoses, adjuvant RT, and location of tumor were not.

scholarly journals Diffuse Low Grade Glioma - A 10-year single institution case series

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv15-iv15
Author(s):  
Shami Acharya ◽  
Priya Sekhon ◽  
Jose Pedro Lavrador ◽  
Ravindran Visagan ◽  
Vijay Narbad ◽  
...  
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Tumour Volume ◽  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Subtotal Resection ◽  
Low Grade ◽  
Single Institution ◽  
The Mean ◽  
Second Procedure

Abstract Objectives To study clinical features and treatment options between 2007–2018 in a population of diffuse low grade glioma (DLGG) patients (WHO Grade2). Methods Single centre retrospective cohort study. Variables reviewed: demographics, extent of resection (biopsy – Bx, subtotal resection – STR, gross total resection – GTR), molecular genetics and outcome. Results N=104.M=61 F=43, average age, 41.8 yrs. For their first surgery, 40.4% underwent a Bx, 32.7% STR, 26.9% GTR. 50.9% of patients had a second procedure due to clinical progression (13.8% Bx, 38.85% STR, 47.2% GTR). We were more surgically aggressive at the second sitting (p=0.0021). After 2014, we were more aggressive in terms of achieving a resection over a biopsy alone (pre 2013: 26 Bx, 24 resection, post 2013: 15 Bx, 28 resection). 35% had 1p19q co-deletion, 70% had 1DH1 mutation and 44.6% with MGMT methylated. There was no difference in survival and extent of resection in 1p19 co-deletions (HR 0.35), however there was in the IDH 1 group (HR 1.25. Post operatively, 37.9% patients had chemotherapy and 57.3 % radiotherapy. 80.5% (Bx 65,9% alive, resection 95% alive) of patients are still alive (longest survival 11.6 yrs). Amongst those who died, the mean overall survival was 4.0 (range 0–7 - 5 years): Of these 14% had undergone a Bx and 6% STR/GTR. The adjusted analysis revealed that EOR is the only revelant factor for survival in the population when adjusted for IDH, 1p19q, tumour volume, age, gender and surgery year (p=0.44). Conclusion Our data emphasises the importance of achieving maximal resection when possible.

Evaluation of Surgical Resection Goal and Its Relationship to Extent of Resection and Patient Outcomes in a Multicenter Prospective Study of Patients With Surgically Treated, Nonfunctioning Pituitary Adenomas: A Case Series

2019 ◽  
Vol 18 (1) ◽  
pp. 26-33
Author(s):  
Andrew S Little ◽  
Michael R Chicoine ◽  
Daniel F Kelly ◽  
Christina E Sarris ◽  
Michael A Mooney ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Predictive Value ◽  
Pituitary Adenomas ◽  
Tumor Resection ◽  
Case Series ◽  
Residual Tumor ◽  
Pituitary Surgery ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Nonfunctioning Pituitary Adenomas

Abstract BACKGROUND The influence of the surgeon's preoperative goal regarding the extent of tumor resection on patient outcomes has not been carefully studied among patients with nonfunctioning pituitary adenomas. OBJECTIVE To analyze the relationship between surgical tumor removal goal and patient outcomes in a prospective multicenter study. METHODS Centrally adjudicated extent of tumor resection (gross total resection [GTR] and subtotal resection [STR]) data were analyzed using standard univariate and multivariable analyses. RESULTS GTR was accomplished in 148 of 171 (86.5%) patients with planned GTR and 32 of 50 (64.0%) patients with planned STR (P = .001). Sensitivity, specificity, positive predictive value, and negative predictive value of GTR goal were 82.2, 43.9, 86.5, and 36.0%, respectively. Knosp grade 0-2, first surgery, and being an experienced surgeon were associated with surgeons choosing GTR as the goal (P &lt; .01). There was no association between surgical goal and presence of pituitary deficiency at 6 mo (P = .31). Tumor Knosp grade (P = .004) and size (P = .001) were stronger predictors of GTR than was surgical goal (P = .014). The most common site of residual tumor was the cavernous sinus (29 of 41 patients; 70.1%). CONCLUSION This is the first pituitary surgery study to examine surgical goal regarding extent of tumor resection and associated patient outcomes. Surgical goal is a poor predictor of actual tumor resection. A more aggressive surgical goal does not correlate with pituitary gland dysfunction. A better understanding of the ability of surgeons to meet their expectations and of the factors associated with surgical result should improve prognostication and preoperative counseling.

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