Assessing the association of tumor consistency and gland manipulation on hormonal outcomes and delayed hyponatremia in pituitary macroadenoma surgery

Schur, Solon; Lasry, Oliver; Tewfik, Marc A.; Maio, Salvatore Di

doi:10.1016/j.inat.2019.100628

Cited by 10 publications

(5 citation statements)

References 67 publications

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“…It may be that the internal structure of the cavernous sinus itself, with trabeculae and ligaments, makes tumor removal difficult or a combination of this with the consistency of the adenoma (3,32). A higher risk of hypopituitarism or hyponatremia, RR = 6.75 (95% CI 3.23, 14.07), has also been described in those patients with fibrous adenomas (33). Several authors have suggested that preoperative radiological features of the PA in the MRI could be useful to predict tumor consistency, especially when radiomic and machine learning on T2-weighted MRI (34), diffusionweighted imaging (35), or MR elastography were employed (36).…”

Section: Discussionmentioning

confidence: 99%

Radiological Knosp, Revised-Knosp, and Hardy–Wilson Classifications for the Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary Adenomas: Study of 228 Cases

et al. 2022

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PurposeTo evaluate which radiological classification, Knosp, revised-Knosp, or Hardy–Wilson classification, is better for the prediction of surgical outcomes in the endoscopic endonasal transsphenoidal (EET) surgery of pituitary adenomas (PAs).MethodsThis is a retrospective study of patients with PAs who underwent EET PA resection for the first time between January 2009 and December 2020. Radiological cavernous sinus invasiveness was defined as a Knosp or revised-Knosp grade >2 or a grade E in the Hardy–Wilson classification.ResultsA total of 228 patients with PAs were included. Cavernous sinus invasion was evident in 35.1% and suprasellar extension was evident in 74.6%. Overall, surgical cure was achieved in 64.3% of patients. Surgical cure was lower in invasive PAs than in non-invasive PAs (28.8% vs. 83.1%, p < 0.0001), and the risk of major complications was higher (13.8% vs. 3.4%, p = 0.003). The rate of surgical cure decreased as the grade of Knosp increased (p < 0.001), whereas the risk of complications increased (p < 0.001). Patients with Knosp 3B PAs tended to achieve surgical cure less commonly than Knosp 3A PAs (30.0% vs. 56.0%, p = 0.164). Similar results were observed based on the invasion and extension of Hardy–Wilson classification (stage A–C 83.1% vs. E 28.8% p < 0.0001, grade 0–II 81.1% vs. III–IV 59.7% p = 0.008). The Knosp classification offered the greatest diagnostic accuracy for the prediction of surgical cure (AUC 0.820), whereas the invasion Hardy–Wilson classification lacked utility for this purpose (AUC 0.654).ConclusionThe Knosp classifications offer a good orientation for the estimation of surgical cure and the risk of complications in patients with PAs submitted to EET surgery. However, the invasion Hardy–Wilson scale lacks utility for this purpose.

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Section: Discussionmentioning

confidence: 99%

Radiological Knosp, Revised-Knosp, and Hardy–Wilson Classifications for the Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary Adenomas: Study of 228 Cases

et al. 2022

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“…Other studies have also reported a higher risk of endocrine complications after TSS in larger tumors, tumor with firm or hard consistency and where the stalk is aggressively manipulated during surgery. [19][20][21] In our study, the size of the tumor and age of the patients did not differ between the two groups.…”

Section: Discussionmentioning

confidence: 42%

In-Hospital Endocrinology Consultation After Transsphenoidal Surgery: Is It Always Necessary?

Clarke

Hebb

Massoud

et al. 2020

Can. J. Neurol. Sci.

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Background: Patients with sellar masses undergoing transsphenoidal surgery (TSS) frequently develop endocrine dysfunction; therefore, in-hospital endocrinology consultation (IHEC) is recommended. However, we wondered whether routine endocrinology assessment of all TSS patients is always necessary. Methods: We developed an IHEC Physician’s Guide to identify patients who would require peri-operative IHEC. An analysis of all patients undergoing TSS for a sellar mass over a 4-year period was conducted to assess the predictive value of the IHEC Physician’s Guide in identifying patients who required IHEC. Results: A total of 116 patients underwent TSS; 24 required IHEC. As expected, the risk of endocrine complications requiring peri-operative endocrine management was significantly higher in the IHEC group versus no-IHEC group (96% vs. 1%; p < 0.001). The negative predictive value of the IHEC Physician’s Guide in identifying patients who did not require IHEC was 0.99 (95% CI 0.9409–0.9997); Fisher’s exact test, p < 0.001), meaning that the IHEC Physician’s Guide successfully identified all but one patient who truly required IHEC. Conclusion: Results from our study show that most patients do not need IHEC after TSS and that those patients requiring IHEC can be reliably predicted at surgery by using a simple IHEC Physician’s Guide.

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“…Prolonged inpatient stays after transsphenoidal surgery are predominantly due to postoperative endocrine abnormalities, frequently caused by over-manipulation of the intra-operative gland ( 20 , 21 ). A study analyzing surgical experience and length of inpatient stay found no difference between experienced and less-experienced surgeons ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

The impact of surgeon’s academic leave on surgical outcomes for endoscopic transsphenoidal resection of pituitary tumors

Yan,

Stovell,

Chang

2024

Gland Surg

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Background Endoscopic surgery has become the mainstay of pituitary surgery, but requires comprehensive surgical training. We evaluate the impact of a surgeon’s academic leave during endoscopic training on surgical outcomes of patients with pituitary tumors. Methods This retrospective study reviewed the surgical outcomes of endoscopic transsphenoidal surgery for pituitary tumors performed by a single surgeon. The last 56 surgical cases were performed between July 2010 and August 2014 before academic leave (Phase 1 surgery group), while another 56 consecutive cases were performed between November 2017 and March 2020 immediately after the surgeon’s academic leave (Phase 2 surgery group). Demographic and clinical characteristics were collected and compared between the two surgery groups. Results Overall, most surgical outcomes of endoscopic transsphenoidal surgery were not affected adversely by the period of academic leave. The operative time and length of hospital stay was lower in the Phase 2 surgery group compared to the Phase 1 surgery group (P<0.05). Postoperative tumor residual, intraoperative cerebrospinal fluid (CSF) leaks and reoperation also decreased significantly in the Phase 2 group compared to the Phase 1 group (P<0.05). Similar results were observed in patients operated using a one-hand/mono-nostril and two-hand/one-and-half nostril technique. Conclusions Academic leave had no negative impact on most surgical outcomes for endoscopic transsphenoidal resection of pituitary tumors. Moreover, a trend toward shorter operative times and length of hospital stays was noted for patients receiving surgery immediately after surgeon’s return from leave.

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Assessing the association of tumor consistency and gland manipulation on hormonal outcomes and delayed hyponatremia in pituitary macroadenoma surgery

Cited by 10 publications

References 67 publications

Radiological Knosp, Revised-Knosp, and Hardy–Wilson Classifications for the Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary Adenomas: Study of 228 Cases

Radiological Knosp, Revised-Knosp, and Hardy–Wilson Classifications for the Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary Adenomas: Study of 228 Cases

In-Hospital Endocrinology Consultation After Transsphenoidal Surgery: Is It Always Necessary?

The impact of surgeon’s academic leave on surgical outcomes for endoscopic transsphenoidal resection of pituitary tumors

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