Extracapsular en bloc resection in pituitary adenoma surgery

Kim, Eui Hyun; Ku, Cheol Ryong; Lee, Mi Kyung; Kim, Sun Ho

doi:10.1007/s11102-014-0587-4

Cited by 33 publications

(38 citation statements)

References 12 publications

(26 reference statements)

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“…It has also been reported that giant pituitary adenoma, repeat surgery, uneven tumor surface and tough texture may increase the risk of postoperative cerebrospinal fluid rhinorrhea (32,33). The results of the present study demonstrated that 9 patients who were preoperatively prescribed bromocriptine, and 5 patients who were not prescribed bromocriptine, experienced intraoperative cerebrospinal fluid leakage.…”

Section: Discussionsupporting

confidence: 52%

Effects of preoperative bromocriptine treatment on prolactin-secreting pituitary adenoma surgery

Cao

Wang

Liu

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. Pituitary adenomas are benign intracranial endocrine tumors, accounting for ~10% of intracranial tumors. The aim of the present study was to analyze the effects of preoperative treatment with bromocriptine on the surgical treatment and postoperative complications of prolactin-secreting pituitary adenomas (prolactinomas). Data from 102 patients whose prolactinomas were surgically treated between March 2006 and March 2010 were retrospectively reviewed in the present study. The study group included 54 patients who had been treated preoperatively with bromocriptine. The patients were examined by magnetic resonance imaging (MRI) of the head and coronal computed tomography (CT) scanning, after which the pathological diagnosis of prolactinoma was confirmed. A total of 64 patients underwent total resection surgery through the nose and sphenoid sinus, and 25 patients underwent subtotal resection surgery or excision of a large portion of the tumor, leaving only a small quantity of residual tumor or tumor capsule. Patients were followed up for 1-9 months using MRI and measurements of serum prolactin levels. Seven patients were lost to follow-up. The results of the present study demonstrated that patients who were treated with large doses of bromocriptine or used bromocriptine chronically suffered from an increased rate of surgical difficulties and postoperative complications, as compared with the patents who had not been pre-treated with bromocriptine. In conclusion, oral administration of bromocriptine is important in the treatment of prolactinoma tumors. However, large doses or long-term use of bromocriptine may increase difficulties in surgery or postoperative complications, and reduce its ability to treat prolactinonas, as it can lead to hardening of the tumor tissue and capsules, and aggravate pituitary stalk adhesions.

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Section: Discussionsupporting

confidence: 52%

Effects of preoperative bromocriptine treatment on prolactin-secreting pituitary adenoma surgery

Cao

Wang

Liu

et al. 2016

Experimental and Therapeutic Medicine

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“…These findings are consistent with those in a series by Kim et al in which piecemeal resection was associated with a significantly lower incidence of gross-total resection than pseudocapsular resection among pituitary adenomas with a Hardy classification of less than 3. 10 As demonstrated here, development of the posterior pseudocapsule establishes a surgical plane and provides a superior opportunity for true gross-total resection and reduces the incidence of residual intrasellar tumor on postoperative imaging in the absence of cavernous sinus invasion (39% vs 10%, p < 0.05 based on preoperative imaging; 50% vs 9%, p < 0.005 based on intraoperative findings); and for any location (extrasellar included) regardless of cavernous sinus invasion (56% vs 34%, p < 0.05; Table 2).…”

Section: Discussionmentioning

confidence: 99%

Resection of pituitary macroadenomas via the pseudocapsule along the posterior tumor margin: a cohort study and technical note

Taylor¹,

Jane²,

Oldfield³

2018

Journal of Neurosurgery

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OBJECTIVE Extracapsular resection of pituitary microadenomas improves remission rates, but the application of pseudocapsular techniques for macroadenomas has not been well described. In larger tumors, the extremely thin, compressed normal gland or its complete absence along the tumor's anterior surface limits the application of the traditional pseudocapsular technique that can be used for microadenomas. However, in the authors' experience, the interface between the pseudocapsule at the posterior margin of the adenoma and the compressed normal gland behind it is universally present, providing a surgical dissection plane. In mid-2010, the authors began using a new surgical technique to identify and use this interface for the resection of larger macroadenomas, a technique that can be used with the microscope or the endoscope. METHODS The authors performed a cohort study using prospectively collected preoperative imaging reports and operative details and retrospectively reviewed postoperative images and clinical follow-up of patients with a pituitary macroadenoma 20-40 mm in maximum diameter undergoing microscopic transsphenoidal resection. Since dissection of the tumor capsule only pertains to encapsulated tumor within the sella and not to tumor invading the cavernous sinus, assessment of tumor removal of noninvasive tumors emphasized the entire tumor, while that of invasive tumors emphasized the intrasellar component only. The incidence of residual tumor on postoperative imaging, new-onset endocrinopathy, and recovery of preoperative pituitary deficits was compared between patients who underwent surgery before (Group A) and after (Group B) implementation of the new technique. RESULTS There were 34 consecutive patients in Group A and 74 consecutive patients in Group B. Tumors in 18 (53%) Group A and 40 (54%) Group B patients had no evidence of cavernous sinus invasion on MRI. Use of the posterior pseudocapsule technique reduced the incidence of intrasellar residual tumor on postoperative MRI for tumors without cavernous sinus invasion (39% [Group A] vs 10%, p < 0.05) and in all tumors regardless of invasion (50% vs 18%, p < 0.005). The incidence of new endocrinopathy was less likely (25% vs 12%, p = 0.098) and the recovery of prior deficits more likely (13% vs 27%, p = 0.199) among patients treated using the pseudocapsule approach, although the differences are not statistically significant. CONCLUSIONS Use of the posterior pseudocapsule dissection plane can enhance the resection of pituitary macroadenomas.

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“…www.e-enm.org 211 ease with close to 35% achieving remission [1,51,54]. Pegvisomant, the representative GHRI, is also mainly indicated for patients with resistance to first-line SSA [1,55].…”

Section: Current Treatment Approachesmentioning

confidence: 99%

“…Another study also showed that it does not increase the risk of postoperative hypopituitarism [63]. Removal of tumor pseudocapsule during transsphenoidal adenomectomy (TSA) improves endocrinological remission rates and no increased risk of postoperative hypopituitarism or cerebrospinal fluid rhinorrhea [55,65]. Somatotropinomas present as macroadenomas (>10 mm in diameter) in 65% to 89% (Table 1) [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][39][40][41][42][43][44][45][46], decreasing the possibility of complete surgical cure and evoking persistent disease in >60% of cases [9].…”

Section: Precision Therapy and Predictors Of Responsivenessmentioning

confidence: 99%

“…1. Flowchart representing current clinical, imaging, histological and molecular predictors, as well as future predictors whose role can be finalized with developments in translational research [2,9,[23][24][25][26][28][29][30][31][32][33][34][35][36][37][38]55,61,[63][64][65][66]. GH, growth hormone; IGF-1, insulin-like growth factor-1; MRI, magnetic resonance imaging; SSTR2, somatostatin receptor subtype 2; D2R, dopamine d2 receptor; AIP, aryl hydrocarbon receptor interacting protein; ZAC1, pleomorphic adenoma gene 1 like zinc finger 1; RKIP, Raf kinase inhibitor protein; GNAS1, guanine nucleotide binding protein, alpha stimulating 1; SST5TMD4, somatostatin receptor subtype 5 splicing variant; SNP, single nucleotide polymorphism.…”

Section: Precision Therapy and Predictors Of Responsivenessmentioning

confidence: 99%

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Precision Therapy in Acromegaly Caused by Pituitary Tumors: How Close Is It to Reality?

Melnikov

Zhang

2020

Endocrinol Metab

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Acromegaly presents with an enigmatic range of symptoms and comorbidities caused by chronic and progressive growth hormone elevations, commonly due to endocrinologic hypersecretion from a pituitary gland tumor. Comprehensive national acromegaly databases have been appearing over the years, allowing for international comparisons of data, although still presenting varying prevalence and incidence rates. Lack of large-scale analysis in geographical and ethnic differences in clinical presentation and management requires further research. Assessment of current and novel predictors of responsiveness to distinct therapy can lead to multilevel categorization of patients, allowing integration into new clinical guidelines and reduction of increased morbidity and mortality associated with acromegaly. This review compares current data from epidemiological studies and assesses the present-day application of prognostic factors in medical practice, the reality of precision therapy, as well as its future prospects in acromegaly, with a special focus on its relevance to the South Korean population.

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Extracapsular en bloc resection in pituitary adenoma surgery

Abstract: Extracapsular resection is critical for radical tumor resection and endocrinological remission. The removal of a pseudocapsule does not increase the risk of postoperative hypopituitarism nor postoperative CSF rhinorrhea.

Cited by 33 publications

References 12 publications

Effects of preoperative bromocriptine treatment on prolactin-secreting pituitary adenoma surgery

Effects of preoperative bromocriptine treatment on prolactin-secreting pituitary adenoma surgery

Resection of pituitary macroadenomas via the pseudocapsule along the posterior tumor margin: a cohort study and technical note

Precision Therapy in Acromegaly Caused by Pituitary Tumors: How Close Is It to Reality?

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