Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery

Dhandapani, Sivashanmugam; Singh, Harminder; Negm, Hazem M; Cohen-Cohen, Salomón; Anand, Vijay K.; Schwartz, Theodore H.

doi:10.1016/j.wneu.2016.08.088

Cited by 117 publications

(83 citation statements)

References 47 publications

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“…The endoscopic inspection is reported to be the best technique to detect cavernous sinus invasion, whereas microscopy tends to overestimate the invasion. 36) However, histological examination remains necessary for some cases to evaluate “occult invasion”, i.e. tumor invasion of the dura or cavernous sinus medial wall that is not evident on imaging studies and is not obvious to the surgeon and, thus, can be the basis of recurrence or persistent tumor and endocrinopathy.…”

Section: Introductionmentioning

confidence: 99%

Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

Nishioka

2017

Neurol. Med. Chir.(Tokyo)

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For the treatment of pituitary tumors, microscopic transsphenoidal surgery has been considered the “gold standard” since the late 1960s. Over the last two decades, however, a worldwide shift towards endoscopic endonasal surgery is in progress for many reasons. These include a wide panoramic view, improved illumination, an ability to look around anatomical corners using angled tip and, in addition, application to the extended approaches for parasellar tumors. Both endoscopic and microscopic approaches appear equally effective for nonfunctioning adenomas without significant suprasellar or lateral extensions, whereas the endoscopic approach may improve outcomes associated with the extent of resection and postoperative complications for larger tumors. Despite many theoretical benefits in the endoscopic surgery, remission rates of functioning adenomas do not substantially differ between the approaches in experienced hands. The endoscopic approach is a valid alternative to the microscopic approach for adenomas. The benefits will be more appreciated in the extended surgery for parasellar tumors.

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Section: Introductionmentioning

confidence: 99%

Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

Nishioka

2017

Neurol. Med. Chir.(Tokyo)

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“…Evidence shows that patients with behavioral symptoms are difficult to be managed, thus increasing the caregivers' burden [5] . These symptoms may be present in the patients since the onset of disease or sometimes may develop later during the disease and treatment process [10,11] . However, there is a paucity of studies done on prospective assessment of neuropsychological symptoms at various time points of the disease process.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Trends in the Neuropsychological Burden of Patients having Intracranial Tumors with Respect to Neurosurgical Intervention

et al. 2017

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Background: The burden of neuropsychological symptoms evidenced by behavioral changes among patients with intracranial tumors has not been studied in detail. Purpose: This study was conducted to prospectively assess the neuropsychological symptoms in patients with intracranial tumors undergoing treatment. Methods: A longitudinal study was conducted using purposive sampling to assess the neuropsychological symptoms in conscious and consenting patients with intracranial tumors who were availing treatment from a tertiary care center. Neuropsychiatric Inventory Questionnaire (NPI-Q), which identifies 12 behavioral disturbances, was assessed at baseline, and later at 1 month and 6 months after treatment, and scored as symptom severity as well as symptom scores. Results: Among the 34 patients studied, all had experienced at least one neuropsychological symptom. The commonest neuropsychological symptoms at baseline were anxiety (82%), agitation (75%), irritability (74%), depression (74%), and sleep disturbances (70%). The neuropsychiatric symptom and severity scores were 5.84 (SD ±2.7) and 11.8 (±7.1) at baseline, which reduced significantly to 4.3 (±3.1) and 5.6 (±3.2) at 1 month, and further to 2.3 (±2.9) and 3.6 (±3.2) at 6 months, respectively. The neuropsychological symptoms persistent at 6 months were anxiety (33%), depression (33%), sleep disturbances (33%), agitation (25%), irritability (25%), and disinhibition (25%). Conclusion: There is substantial neuropsychological burden among patients with intracranial tumors. The severity score improved immediately after surgery, while the symptom score improved gradually. The variable spectrum of improvement in neuropsychological symptoms at 6 months after surgical treatment needs further consideration. Addressing these symptoms should be one of the long-term goals of the neuro-oncology teams.

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“…Transsphenoidal pituitary surgery by microscopic or endoscopic approach: the still unsolved question of superiority Eduardo de Arnaldo S. Vellutini 1 …”

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confidence: 99%

“…There still are controversies among pituitary surgeons about the superiority of endoscopic techniques (1,2). In this issue of the AE&M, Bastos and cols.…”

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confidence: 99%

“…As a matter of fact, such comparisons are difficult to evaluate due to different number of cases (larger in microscopic series), distinct eras of pituitary surgery (series from different Nevertheless, endoscopic pituitary surgery has clearly changed some paradigms. Tumors located in the cavernous sinus, which were previously referred for radiotherapy (1), and tumors with large suprasellar extension, which were operated by a standard craniotomy (4), can now be removed by endoscopic transnasal extended approaches with good results and acceptable complications.…”

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Transsphenoidal pituitary surgery by microscopic or endoscopic approach: the still unsolved question of superiority

Vellutini¹

2016

Arch. Endocrinol. Metab.

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S urgery has been the main treatment of pituitary tumors since the beginning of last century. Pioneers like Cushing, Hirsch, and Schloffer were able to foresee the advantages of the transsphenoidal approaches but had to abandon them due to technical difficulties, specially those related to surgical field lighting. Even though this method was maintained by Norman Dott, in England, and Gerard Guiot, in France, it was only in the beginning of the sixties that Jules Hardy, in Canada, brought the surgical microscope to the operating room.Since then, the microscopic transsphenoidal approach became the gold standard for the treatment of pituitary tumors. Meanwhile, in the middle of the nineties, endoscopic surgery had already proven its efficacy in the treatment of nasosinusal diseases and, thus, its use in sellar diseases became a matter of time. The wide-angle view associated with a light source near the surgical field brought about a large number of possibilities, not only for pituitary surgery but also in the whole field of skull base surgery.In the last years, the indications for endoscopic pituitary surgery have gradually overcome those for microscopic surgery. View of the surgical field, the Achilles' heel of Cushing almost a hundred years ago, is the main advantage of this technique. Surely, surgeons must adapt to the changes in the operating room, to the use of a video monitor and to a two-dimensional surgical view with a different anatomic perspective. However, those difficulties should be faced after proper laboratory training, and it should be considered that learning may probably be faster for a young than for a senior surgeon.Endoscopy has also brought the rhinologist to the field of pituitary surgery, which can be seen as a great advantage. Results were improved, developing multidisciplinary cooperation, bringing about many technical innovations in the operative room, improving nasal functional results in patients, as well.There still are controversies among pituitary surgeons about the superiority of endoscopic techniques (1,2). In this issue of the AE&M, Bastos and cols. (3), by means of a meta-analysis of the literature, tried to figure out which may be the best indication for the patient, presenting pooled data on surgical success, outcomes, and complications of both techniques. They did not find a significant differences between endoscopic and microscopic TSS in relation to pituitary tumor resection rates and achievement of biochemical control of functioning pituitary adenomas, but pointed out that, due to the low level of evidence and small number of observations, the results of their meta-analysis should not be viewed as a final proof of inferiority or superiority of one approach in relation to the other. Nonetheless, postoperative complications seemed to be less frequent with the endoscopic procedure. As a matter of fact, such comparisons are difficult to evaluate due to different number of cases (larger in microscopic series), distinct eras of pituitary surgery (series from different

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Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-Analysis of Radiologic Criteria and Comparison of Endoscopic and Microscopic Surgery

Cited by 117 publications

References 47 publications

Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

Recent Evolution of Endoscopic Endonasal Surgery for Treatment of Pituitary Adenomas

Prevalence and Trends in the Neuropsychological Burden of Patients having Intracranial Tumors with Respect to Neurosurgical Intervention

Transsphenoidal pituitary surgery by microscopic or endoscopic approach: the still unsolved question of superiority

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