Endoscopic Endonasal Approach for Adrenocorticotropic Hormone-Secreting Pituitary Adenomas: Outcomes and Analysis of Remission Rates and Tumor Biochemical Activity with Respect to Tumor Invasiveness

Shin, Samuel S.; Gardner, Paul A.; Ng, Jason; Faraji, Amir H.; Agarwal, Nitin; Chivukula, Srinivas; Fernández-Miranda, Juan C.; Snyderman, Carl H.; Challinor, Sue M.

doi:10.1016/j.wneu.2015.07.065

Cited by 22 publications

(22 citation statements)

References 35 publications

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“…After a detailed evaluation of these articles, 80 studies remained for assessment. After applying the selection criteria, 36 cohort studies involving 4326 patients were identified and included in the meta-analysis ( 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ). In these 36 studies, 2656 patients were included in 12 studies ( 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ) with treatments prior to 1990 and long-term follow-up.…”

Section: Resultsmentioning

confidence: 99%

“…Owing to these advantages, increasing numbers of neurosurgeons have started to adopt the endoscopic technique in recent years. Compared with microscopic surgery, endoscopic transsphenoidal tumor resection seems to lead to improved patient outcomes, especially in those patients with cavernous sinus invasion ( 14 , 15 , 16 , 17 , 18 , 19 , 20 ). In patients with CD, though a few studies do indicate a lower recurrence rate ( 15 , 21 , 22 ), it is still unclear whether the endoscopic technique has any advantages.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Qiao

2018

Endocrine Connections

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IntroductionIt is unclear whether the proportions of remission and the recurrence rates differ between endoscopic transsphenoidal surgery (TS) and microscopic TS in Cushing’s disease (CD); thus, we conducted a systematic review and meta-analysis to evaluate studies of endoscopic TS and microscopic TS.MethodsWe conducted a comprehensive search of PubMed to identify relevant studies. Remission and recurrence were used as outcome measures following surgical treatment of CD.ResultsA total of 24 cohort studies involving 1670 adult patients were included in the comparison. Among these studies, 702 patients across 9 studies underwent endoscopic TS, and 968 patients across 15 studies underwent microscopic TS. Similar baseline characteristics were observed in both groups. There was no significant difference in remission between the two groups: 79.7% (95% CI: 73.1–85.0%) in the endoscopic group and 76.9% (95% CI: 71.3–81.6%) in the microscopic group (P = 0.485). It appears that patients who underwent endoscopic surgery experience recurrence less often than patients who underwent microscopic surgery, with recurrence proportions of 11.0% and 15.9%, respectively (P = 0.134). However, if follow-up time is taken into account, both groups had a recurrence rate of approximately 4% per person per year (95% CI: 3.1–5.4% and 3.6–5.1%, P = 0.651).ConclusionsWe found that remission proportion and recurrence rate were the same in patients who underwent endoscopic TS as in patients who underwent microscopic TS. The definition of diagnosis, remission and recurrence should always be considered in the studies assessing therapeutic efficacy in CD.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Qiao

2018

Endocrine Connections

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“…It is therefore not surprising that the outcome of TSS is significantly influenced by the experience and expertise of the pituitary neurosurgeon . In expert hands, postoperative remission of hypercortisolism, usually defined as very low morning serum cortisol levels in the early postoperative period [and in some centres, supported by very low 24‐hour urine free cortisol (UFC) and late‐night salivary cortisol (LNSC) during that time ], is achieved in up to ~90% of patients with microadenomas and ~65% of patients with macroadenomas (Table ) . Other predictors of postoperative remission include preoperative or intraoperative tumour visualization and pathological confirmation of the diagnosis .…”

Section: Pituitary Surgerymentioning

confidence: 99%

Current management of Cushing's disease

Tritos

Biller

2019

J Intern Med

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“…9,10 However, several studies have found a low correlation between BIPSS and tumor lateralization, 11,12 and several have stated BIPSS cannot be used to accurately lateralize lesions within the pituitary. 13,14 The fact that several reputed authors have published their own treatment algorithm including BIPSS shows that while useful as a diagnostic tool, its true effectiveness in preoperative planning and prognosis is yet to be ascertained. We present a series of 52 consecutive patients with a confirmed diagnosis of Cushing's disease without any abnormalities in 3T MRI, their intraoperative findings, and postoperative results in an effort to clarify the role of BIPSS as a surgical planning tool and its relevance as a prognostic factor.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Bilateral Inferior Petrosal Sinuses Sampling in Tumor Lateralization: Intraoperative Findings and Postoperative Results

et al. 2017

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Diagnosis and treatment of Cushing's disease (CD) is a demanding endeavor. We evaluated the effectiveness of inferior petrosal sinus sampling (IPSS) in preoperative tumor lateralization and surgical outcomes. Fifty-two consecutive patients with CD and normal magnetic resonance imaging (MRI) were enrolled between 2009 and 2015. Selective catheterization of petrosal sinuses for IPSS was performed. All patients underwent microsurgical dissection, and if a lesion was found, underwent lesion resection. Demographic, biochemical, and intraoperative findings were prospectively collected and reviewed 6 and 12 months postoperatively. Forty-five patients (86.4%) had clear lateralization while seven patients had bilateral elevation. Twenty-two patients (42%) were found to have a macroscopic lesion, defined as an abnormal tissue during microsurgical dissection, which was thus resected. No patient had a lesion larger than 4 mm. Eighty-one percent of patients had the lesion where IPSS had been predicted. Hemi-hypophysectomy was performed on twenty-eight patients based on IPSS findings, since no lesion was found. Eighty-six percent of patients with lesion resection had biochemical remission by 12 months. Biochemical remission was documented in 78 and 71% of patients who underwent hemi-hypophysectomy by 6 and 12 months, respectively. With careful microsurgical dissection, a macroscopic lesion could be found in a significant number of patients with normal MRI. When no lesion was found, we recommend performing a hemi-hypophysectomy based on IPSS findings, since prediction accuracy was high and remission rates were significant.

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Endoscopic Endonasal Approach for Adrenocorticotropic Hormone-Secreting Pituitary Adenomas: Outcomes and Analysis of Remission Rates and Tumor Biochemical Activity with Respect to Tumor Invasiveness

Cited by 22 publications

References 35 publications

Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Current management of Cushing's disease

Effectiveness of Bilateral Inferior Petrosal Sinuses Sampling in Tumor Lateralization: Intraoperative Findings and Postoperative Results

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