Various strategies of transsphenoidal pseudocapsule-based extracapsular resection in noninvasive functional pituitary adenomas and their effectiveness and safety

Abstract PurposeExtracapsular resection of pituitary microadenomas has been widely reported, but only a few studies have carried out further investigations in macroadenomas, especially using the endonasal endoscopic approach. The authors of this study combined not only the interoperative characteristics of pituitary adenomas and pseudocapsules but also the surgical technique, outcomes and complications in macroadenomas to investigate the pseudocapsule.MethodsIn total, 143 consecutive patients with pituitary adenomas (maximum diameter 15 - 40 mm) who underwent endoscopic endonasal-transsphenoidal surgery between January 1, 2017, and August 1, 2019, were included in the study. ResultsAmong 143 patients, 48 patients had an intact pseudocapsule, 56 patients possessed an incomplete pseudocapsule and the remaining 38 patients had no pseudocapsule. A white and thick pseudocapsule was more frequent (p=0.016) in fibrous adenomas, but tumor fibrosis (p=0.004) and adenoma apoplexy (p<0.001) were the factors that predicted the pseudocapsular integrity and hindered en bloc extracapsular resection according to a logistic regression analysis. In addition, the adenoma size (p=0.185) did not influence pseudocapsular integrity. Partial capsulectomy for macroadenomas did not show a significant advantage over piecemeal resection in gross total tumor resection (GTR) or biochemical remission (p=0.731 and p=0.685, respectively), but GTR in whole capsular resection was 100%. Additionally, this resection method had a higher risk of intraoperative cerebrospinal fluid leakage (p=0.010) and a lower incidence of new hormone deficit (p=0.043) than piecemeal resection.ConclusionsThe pseudocapsule widely exists in pituitary macroadenomas and extracapsular resection can improve GTR and hormone remission rate and reduce the occurrence of postoperative pituitary dysfunction in short-time.

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Transsphenoidal pseudocapsule-based extracapsular resection for pituitary adenomas

Acta Neurochirurgica ◽

10.1007/s00701-011-0961-1 ◽

2011 ◽

Vol 153 (4) ◽

pp. 799-806 ◽

Cited By ~ 13

Author(s):

Xin Qu ◽

Jun Yang ◽

Ji-Dong Sun ◽

Cheng-Zhi Mou ◽

Guo-Dong Wang ◽

...

Keyword(s):

Pituitary Adenomas ◽

Extracapsular Resection

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Pseudocapsule-Based Resection for Pituitary Adenomas via the Endoscopic Endonasal Approach

Frontiers in Oncology ◽

10.3389/fonc.2021.812468 ◽

2022 ◽

Vol 11 ◽

Author(s):

Yuefei Zhou ◽

Jialiang Wei ◽

Feng Feng ◽

Jianguo Wang ◽

Pengfei Jia ◽

...

Keyword(s):

Pituitary Adenomas ◽

Tumor Resection ◽

Csf Leak ◽

Safe Procedure ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Csf Leakage ◽

Extracapsular Resection

IntroductionThe endoscopic endonasal approach (EEA) is a safe and effective treatment for pituitary adenomas (PAs). Since extracapsular resection (ER) of PAs improves tumor resection and endocrine remission rates, the interface between the pseudocapsule and gland draws increasing attention. However, it is difficult to precisely dissect the tumor along the exact boundary, and complete removal of the tumor increases the risks of normal tissue damage and cerebrospinal fluid (CSF) leakage. In this study, we investigated the extracapsular resection as well as the pseudocapsule histology to evaluate the effectiveness and safety of pseudocapsule-related surgical interventions.MethodsFrom December 2017 to December 2019, 189 patients of PAs via EEA in our single center were analyzed retrospectively. The images, operative details, and clinical follow-up of patients were collected. Sixty-four patients underwent pseudocapsule-based ER, and 125 patients also underwent traditional intracapsular resection (IR) with or without intensive excision for FPAs. The clinical characteristics, tumor resection, endocrinological outcomes, and postoperative morbidities of the two groups were compared. Informed consent for publication of our article was obtained from each patient. Histological examination of pseudocapsule was performed using hematoxylin and eosin and reticulin staining.ResultsThe gross total recession was 62 (96.9%) in the ER group and 107 (85.6%) cases in the IR group, whereas the endocrine remission rate was 29/31 (93.5%) and 40/53 (75.5%) cases, respectively. Anterior pituitary functions were not aggravated postoperatively in any patient, but transient diabetes insipidus (DI) occurred more in the IR group (64.0%) than in ER (48.4%). Pseudocapsule specimens were obtained in 93 patients, and clusters of small cell aggregation were detected in 11 pseudocapsule specimens (11.8%) whereas other patients showed no remarkable developed pseudocapsule. Intraoperative CSF leak occurred more in the ER group (28.1%) than in the IR group (13.6%), but no difference was seen between two groups postoperatively. No case of intracranial hematoma or pituitary crisis occurred in both groups. After a mean follow-up of 22.8 months, tumor recurrence was observed in 4 (2.1%) cases.ConclusionPseudocapsule-based extracapsular resection of PAs via EEA is an effective and safe procedure to achieve complete resection with high and sustained endocrine remission and without deteriorating pituitary function.

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Extracapsular resection of noninvasive functional pituitary adenomas

Neurology India ◽

10.4103/0028-3886.273656 ◽

2019 ◽

Vol 67 (6) ◽

pp. 1456

Author(s):

Chandrashekhar Deopujari ◽

Aniruddha Bhagwat

Keyword(s):

Pituitary Adenomas ◽

Extracapsular Resection

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Ultrastructural Investigation of Spontaneous Pituitary Adenomas in Aging Sprague-Dawley Rats

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100053747 ◽

1982 ◽

Vol 40 ◽

pp. 216-217

Author(s):

D. J. McComb ◽

J. Beri ◽

F. Zak ◽

K. Kovacs

Keyword(s):

Microscopic Study ◽

Pituitary Adenomas ◽

Wistar Rats ◽

Microscopic Level ◽

Sprague Dawley ◽

Prolactin Cells ◽

Light Microscopic Level ◽

Ultrastructural Investigation ◽

Sprague Dawley Rats ◽

Long Evans

Investigation of the spontaneous pituitary adenomas in rat have been limited mainly to light microscopic study. Furth et al. (1973) described them as chromophobic, secreting prolactin. Kovacs et al. (1977) in an ul trastructural investigation of adenomas of old female Long-Evans rats, found that they were composed of prolactin cells. Berkvens et al. (1980) using immunocytochemistry at the light microscopic level, demonstrated that some spontaneous tumors of old Wistar rats could contain GH, TSH or ACTH as well as PRL.

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Ultrastructural comparison of prolactin adenomas of pituitary in men and women

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100103796 ◽

1988 ◽

Vol 46 ◽

pp. 346-347

Author(s):

R.C. Caughey ◽

U.P. Kalyan-Raman

Keyword(s):

Endoplasmic Reticulum ◽

Electron Microscope ◽

Phosphate Buffer ◽

Pituitary Adenomas ◽

Osmium Tetroxide ◽

Secretory Granules ◽

Uranyl Acetate ◽

En Bloc ◽

Men And Women ◽

Transmission Electron

Prolactin producing pituitary adenomas are ultrastructurally characterized by secretory granules varying in size (150-300nm), abundance of endoplasmic reticulum, and misplaced exocytosis. They are also subclassified as sparsely or densely granulated according to the amount of granules present. The hormone levels in men and women vary, being higher in men; so also the symptoms vary between both sexes. In order to understand this variation, we studied 21 prolactin producing pituitary adenomas by transmission electron microscope. This was out of a total of 80 pituitary adenomas. There were 6 men and 15 women in this group of 21 prolactinomas.All of the pituitary adenomas were fixed in 2.5% glutaraldehyde, rinsed in Millonig's phosphate buffer, and post fixed with 1% osmium tetroxide. They were then en bloc stained with 0.5% uranyl acetate, rinsed with Walpole's non-phosphate buffer, dehydrated with graded series of ethanols and embedded with Epon 812 epoxy resin.

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Fine Structural Classification of Chromophobe Adenomas of the Human Pituitary Gland

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100115511 ◽

1975 ◽

Vol 33 ◽

pp. 378-379

Author(s):

K. Kovacs ◽

E. Horvath

Keyword(s):

Pituitary Adenomas ◽

Secretory Activity ◽

Microscopic Investigation ◽

Uranyl Acetate ◽

Electron Microscopic Investigation ◽

Electron Microscopic ◽

Human Pituitary ◽

Cytoplasmic Staining ◽

Human Pituitary Gland ◽

Microscopic Features

Chromophobe pituitary adenomas arise from adenohypophysial cells and fail to exhibit cytoplasmic staining with conventional acid or basic dyes by light microscopy. The aim of the present work was to study the electron microscopic features of these tumors, to separate them into distinct entities and to correlate their fine structural appearances with secretory activity.Among 48 surgically removed various pituitary adenomas 30 tumors were found which, based on the tinctorial characteristics of the cytoplasm, corresponded to chromophobe adenomas. For electron microscopic investigation pieces of these tumors were fixed in 2.5 per cent glutaraldehyde in Sorensen's buffer, post fixed in 1 per cent osmium tetroxide in Millonig's buffer, dehydrated in graded ethanol and embedded in Epon 812. Ultrathin sections were stained with uranyl acetate and lead citrate.By electron microscopy it was possible to separate chromophobe adenomas into 3 distinct entities: 1) adenomas consisting of sparsely granulated growth hormone cells (7 cases).

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Ultrastructural Immunocytochemistry of Five Rat Pituitary Adenomas

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s1431927600003147 ◽

1980 ◽

Vol 38 ◽

pp. 724-725

Author(s):

D. J. McComb ◽

N. Ryan ◽

E. Horvath ◽

K. Kovacs ◽

E. Nagy ◽

...

Keyword(s):

Pituitary Adenomas ◽

Pituitary Tumors ◽

Electron Microscopic ◽

Electron Microscopic Immunocytochemistry ◽

Transmission Electron ◽

Rat Pituitary ◽

Radiation Induced ◽

Group 5 ◽

Group 2 ◽

Microscopic Techniques

Conventional light and electron microscopic techniques failed to clarify the cellular composition and derivation of spontaneous and induced, intrasellar and transplanted pituitary adenomas in rats (1). In the present work, electron microscopic immunocytochemistry was applied to evaluate five adenohypo-physial tumors using a technique described by Moriarty and Garner (2). Spontaneously occurring pituitary adenomas (group 1) were harvested from aging female Long-Evans rats. R-Amsterdam rats were treated with 2 x 1.0 mg estrone acetate (HogivaI) s.c. weekly for 6 months. Pituitary adenomas in excess of 30 mg were removed from these animals to make up the tumors of group 2. Groups 3 and 4 consisted of estrogen-induced autonomous transplan¬ted pituitary tumors MtT.WlO and MtT.F4. Group 5 was a radiation-induced transplanted autonomous pituitary tumor MtT.W5. The tumors of groups 3,4 and 5 were allowed to proliferate in host rats 6-8 weeks prior to removal for processing. Tissue was processed for transmission electron microscopy (glutaraldehyde fixation, OsO4 postfixation and epoxy resin embedding), and electron microscopic immunocytochemistry (3% paraformaldehyde fixation and Araldite embedding).

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