Identification of the Extradural and Intradural Extension of Pituitary Adenomas to the Suprasellar Region: Classification, Surgical Strategies, and Outcomes

Yang, Youqing; Bao, Youyuan; Xie, Shenhao; Tang, Bin; Wu, Xiao; Yang, Liangle; Wu, Jie; Ding, Heyu; Li, Shaoyang; Zheng, Suyue; Hong, Tao

doi:10.3389/fonc.2021.723513

Cited by 6 publications

(3 citation statements)

References 34 publications

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“…Similarly, Yang et al. ( 38 ) described expressly that PAs with intracranial extension had increased surgical complications and a lower rate of gross total removal, although not describing Knosp grades. On the other hand, other authors found that the remission rate was not associated with sellar floor erosion according to the Hardy–Wilson system of grading, neither with supra- and parasellar extension ( 39 , 40 ).…”

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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“…The suprasellar extension will mechanically destroy the structure of the sellar septum. Once the suprasellar extension of pituitary adenomas is located in the dura mater and connected with the skull cavity, it will increase the incidence of surgical complications [12].…”

Section: Discussionmentioning

confidence: 99%

Predictive Value Of Suprasellar Extension For Intracranial Infection After Endoscopic Transsphenoidal Pituitary Adenoma Resection

Lin,

Wang,

Tang

et al. 2023

Preprint

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OBJECTIVE: To investigate the relationship between suprasellar extension (SSE) and intracranial infection after Endoscopic endonasal transsphenoidal approach (EETA) for pituitary adenoma resection. METHODS: We retrospectively analyzed 94 patients with suprasellar extended pituitary adenoma admitted to the Department of Neurosurgery of the Affiliated Hospital of Guilin Medical College from January 2018 to December 2021. We measured the preoperative magnetic resonance sagittal SSE and collected clinical data and divided the patients into groups according to the presence of postoperative intracranial infection. The critical value for the SSE was calculated by using a working characteristic curve for the subjects. The risk factors for intracranial infection after EETA resection of pituitary adenomas were analyzed by multivariate regression analysis. RESULTS: Among the 94 patients, 12 cases (12.8%) were placed in the infection group and 82 cases (87.2%) in the non-infection group. The cut-off value for the SSE in the sagittal position was 15.6 mm, the sensitivity was 75%, the specificity was 87.8%, and the area under the curve (AUC) was 0.801; The coronary cut-off value for the SSE was 15.8mm, the sensitivity was 66.7%, the specificity was 79.3%, and the AUC was 0.787; The SSE values in the sagittal and coronal positions were correlated with postoperative intracranial infection (P<0.05). After univariate analysis, those with significant differences were included in the multivariate regression analysis. It was concluded that the extension distance of the tumor above the sella in the sagittal position was ≥15.6 mm, the tumor texture was hard, and the postoperative cerebrospinal fluid leakage were the independent risk factors for intracranial infection after EETA resection of suprasellar extended pituitary tumors (P < 0.05). CONCLUSIONS: The value of SSE on sagittal MRI can predict intracranial infection in patients with suprasellar extended pituitary adenoma after endoscopic endonasal transsphenoidal resection. This finding recommends neurosurgeons to pay more attention to the imaging characteristics of pituitary adenomas and select appropriate treatment plans in combination with the intraoperative conditions to reduce the incidence of intracranial infection.

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“…In contrast, the supracarotid height was the distance measured from the midpoint joining both genu of the cavernous internal carotid artery to the most cranial portion of the tumor. 5 On the other hand, the extent of lateral compression, measured by Knosp grading, was recorded, signifying optic nerve compression. 6 Postoperative visual outcomes were assessed with visual acuity (VA), VF, and visual impairment scale (VIS).…”

Section: Methodsmentioning

confidence: 99%

A Factorial Analysis on Visual Outcomes of Transsphenoidal Surgery for Pituitary Macroadenoma

Mak

Steffi

et al. 2022

Asian J Neurosurg

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Objective Sellar lesions are possible reversible causes of vision loss. This study is to provide quantitative objective measurement of efficacy of surgery for non-functioning pituitary adenoma and discuss different factors that could affect visual outcome of non-functioning pituitary adenoma. Method This is a single centre, retrospective study conducted at a tertiary neurosurgery referral centre. 108 cases of sellar tumors which underwent surgery during the 3-year period from early June 2015 to late May 2018 were reviewed. Pituitary adenoma that were non-functioning and without apoplexy at initial presentation were selected for the study. We have analyzed the correlation of different factors with the visual outcome, including the extent of vertical decompression in terms of change in tumor height post operation and the extent of lateral decompression in terms of change in Knosp grading. Visual outcome was represented by the visual impairment score (VIS), an integrated measurement of visual acuity and visual field deficit. Results Preoperative absolute tumor height and supracarotid height correlated with preoperative VIS scale (p ≤ 0.01). Absolute Knosp grading correlates significantly with VA (p = 0.001) and VF (p ≤ 0.001) of that particular eye. Although most patients had an objective improvement in visual acuity (VA) (88%) and visual field (VF) (99%) after operation, a larger reduction in tumor height and successful Knosp downgrading after surgery is associated with better VIS improvement. (p = 0.025) Change in supracarotid height shows trend in correlating with change in VIS (p = 0.084). Conclusion Height of tumor measured from genu of cavernous ICA correlates better with visual outcome than absolute tumor height. The extent of both vertical and lateral decompression of non-functioning pituitary adenoma are important determinants that lead to better visual outcome. As endoscopic approach is able to achieve a greater degree of lateral decompression, it is a preferred approach in pituitary surgery to achieve a better visual outcome.

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Identification of the Extradural and Intradural Extension of Pituitary Adenomas to the Suprasellar Region: Classification, Surgical Strategies, and Outcomes

Cited by 6 publications

References 34 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

Predictive Value Of Suprasellar Extension For Intracranial Infection After Endoscopic Transsphenoidal Pituitary Adenoma Resection

A Factorial Analysis on Visual Outcomes of Transsphenoidal Surgery for Pituitary Macroadenoma

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