Endoscopic Surgery for Pituitary Tumors

Furth, Wouter R. van; Vries, Friso de; Lobatto, Daniel J.; Kleijwegt, Maarten; Schutte, Pieter J.; Pereira, Alberto M.; Biermasz, Nienke R.; Verstegen, Marco J. T.

doi:10.1016/j.ecl.2020.05.011

Cited by 19 publications

(20 citation statements)

References 27 publications

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“…Others, on the contrary, summarized optimistic results ( 13 ). Typically, since repeated PA surgery has been proved safe for the experienced doctors and well tolerated by patients, intact pituitary gland function is deemed more important than adenoma total removal ( 14 ), Theoretically, it is hard for surgeons to extirpate only tumor cells completely during surgery without removing any normal pituitary gland tissue because in most cases the adenoma directly contacts with the normal pituitary gland. Thus, although we might resect a thin layer of anterior pituitary gland when resecting the tumor using the ER method, a meticulous operation could avoid extra collateral damage of the pituitary gland and do no more harm than the traditional IR way.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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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Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…In some cases of giant adenomas or post-operative apoplexy in a suprasellar adenoma remnant, a craniotomy or combined endoscopic transsphenoidal and microscopic transcranial surgery was performed. We described our surgical approach in detail in a recent review ( 31 ).…”

Section: Methodsmentioning

confidence: 99%

Costs and Its Determinants in Pituitary Tumour Surgery

Dekkers

Vries²,

Najafabadi³

et al. 2022

Front. Endocrinol.

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PurposeValue-based healthcare (VBHC) provides a framework to improve care by improving patient outcomes and reducing healthcare costs. To support value-based decision making in clinical practice we evaluated healthcare costs and cost drivers in perioperative care for pituitary tumour patients.MethodsWe retrospectively assessed financial and clinical data for surgical treatment up to the first year after surgery of pituitary tumour patients treated between 2015 and 2018 in a Dutch tertiary referral centre. Multivariable regression analyses were performed to identify determinants of higher costs.Results271 patients who underwent surgery were included. Mean total costs (SD) were €16339 (13573) per patient, with the following cost determinants: surgery time (€62 per minute; 95% CI: 50, 74), length of stay (€1331 per day; 95% CI 1139, 1523), admission to higher care unit (€12154 in total; 95% CI 6413, 17895), emergency surgery (€10363 higher than elective surgery; 95% CI: 1422, 19305) and postoperative cerebrospinal fluid leak (€14232; 95% CI 9667, 18797). Intradural (€7128; 95% CI 10421, 23836) and combined transsphenoidal/transcranial surgery (B: 38494; 95% CI 29191, 47797) were associated with higher costs than standard. Further, higher costs were found in these baseline conditions: Rathke’s cleft cyst (€9201 higher than non-functioning adenoma; 95% CI 1173, 17230), giant adenoma (€19106 higher than microadenoma; 95% CI 12336, 25877), third ventricle invasion (€14613; 95% CI 7613, 21613) and dependent functional status (€12231; 95% CI 3985, 20477). In patients with uncomplicated course, costs were €8879 (3210) and with complications €17551 (14250).ConclusionsLength of hospital stay, and complications are the main drivers of costs in perioperative pituitary tumour healthcare as were some baseline features, e.g. larger tumors, cysts and dependent functional status. Costs analysis may correspond with healthcare resource utilization and guide further individualized care path development and capacity planning.

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“…The time of starting treatment was defined as the day of surgery or the day of starting hydrocortisone supplementation for surgical and conservative treatment, respectively. Surgery was performed using an endonasal endoscopic approach [15]. Emergency and more elective surgery was defined as surgery within or after 3 days of arrival at the expertise center.…”

Section: Clinical Parametersmentioning

confidence: 99%

Towards a pituitary apoplexy classification based on clinical presentation and patient journey

et al. 2022

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Purpose The condition of pituitary apoplexia contains the clinical spectre from life-threatening emergency to asymptomatic self-limiting course, which partly determines diagnostic delay and management. Outcome evaluation of course and management of pituitary apoplexia is hampered by the diverse presentation of this condition and requires appraisal. This study aimed to describe the patient journey, clinical presentation, and management of various types of pituitary apoplexy in a new classification to facilitate future outcome evaluation and identify unmet needs in the care process. Methods A single-center retrospective patient chart study was conducted between 2005–2021 (N = 98). Outcome measures were clinical symptoms at first presentation in hospital, being headache, consciousness, visual acuity, visual field defects (VFD), ophthalmoplegia, nausea, vomiting, fever, and hypopituitarism and care process characteristics. Results Mean age was 47.6 ± 16.6 years (51.0% male). We describe their patient journey and identified three different types, differing in clinical presentation, in-hospital route, and final treatment, e.g., Acute (type A, 52%), Subacute (type B, 22.5%), and Non-acute (type C, 25.5%). Type A generally presents with acute onset headaches, VFD, or ophthalmoplegia emergency setting, with lowest mean visual acuity of both eyes and frequent hypocortisolism. Conclusions Pituitary apoplexy can be approached as a spectrum of disease with 3 main subtypes, with a different initial presentation, different in-hospital route resulting in different management. Acknowledging subtypes with particular needs for (emergency) referrals to Pituitary Tumors Center of Excellence (PTCOE) will serve patient care improvements, outcome evaluations and address areas for improvement.

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Endoscopic Surgery for Pituitary Tumors

Cited by 19 publications

References 27 publications

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

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

Costs and Its Determinants in Pituitary Tumour Surgery

Towards a pituitary apoplexy classification based on clinical presentation and patient journey

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