Outcomes of surgical treatment for nonfunctioning pituitary adenomas: a systematic review and meta‐analysis

Murad, M. Hassan; Fernández-Balsells, Mercè; Barwise, Amelia; Gallegos‐Orozco, Juan F.; Paul, Anu; Lane, Melanie A.; Lampropulos, Julianna F.; Natividad, Inés; Perestelo-Pérez, Lilisbeth; León-Lovatón, Paula G. Ponce de; Albuquerque, Felipe N.; Carey, Jantey; Erwin, Patricia J.; Montori, Víctor M.

doi:10.1111/j.1365-2265.2010.03875.x

Cited by 121 publications

(89 citation statements)

References 53 publications

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“…Furthermore, the risk of tumor recurrence was higher in patients with residual tumor and in those who did not receive radiotherapy (13,14). A meta-analysis also showed that lack of radiotherapy after initial pituitary surgery was associated with an increased risk of tumor recurrence surgery (18). In addition, high Ki-67 and TUNEL labeling indices, as well as the expression of phosphoAkt, phospho-p44/42 MAPK, and PTTG1, were associated with NFPA recurrence, although that study assessed those cell proliferation markers in only 35 patients with NFPA (20).…”

Section: █ Discussionmentioning

confidence: 92%

Is positive staining of nonfunctioning pituitary adenomas for luteinizing hormone associated with poor prognosis?

Diri

Özaslan²,

Kurtsoy³

et al. 2015

Turkish Neurosurgery

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Section: █ Discussionmentioning

confidence: 92%

Is positive staining of nonfunctioning pituitary adenomas for luteinizing hormone associated with poor prognosis?

Diri

Özaslan²,

Kurtsoy³

et al. 2015

Turkish Neurosurgery

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“…Certain studies reported improved pituitary function following surgery [36] whereas others did not mention any change or else reported deterioration.…”

Section: Nonfunctioning Macroadenomamentioning

confidence: 95%

Management of nonfunctioning pituitary incidentaloma

Galland

Vantyghem

Cazabat

et al. 2015

Annales d'Endocrinologie

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Prevalence of pituitary incidentaloma is variable: between 1.4% and 27% at autopsy, and between 3.7% and 37% on imaging. Pituitary microincidentalomas (serendipitously discovered adenoma <1cm in diameter) may increase in size, but only 5% exceed 10mm. Pituitary macroincidentalomas (serendipitously discovered adenoma>1cm in diameter) show increased size in 20-24% and 34-40% of cases at respectively 4 and 8years' follow-up. Radiologic differential diagnosis requires MRI centered on the pituitary gland. Initial assessment of nonfunctioning (NF) microincidentaloma is firstly clinical, the endocrinologist looking for signs of hypersecretion (signs of hyperprolactinemia, acromegaly or Cushing's syndrome), followed up by systematic prolactin and IGF-1 assay. Initial assessment of NF macroincidentaloma is clinical, the endocrinologist looking for signs of hormonal hypersecretion or hypopituitarism, followed up by hormonal assay to screen for hypersecretion or hormonal deficiency and by ophthalmologic assessment (visual acuity and visual field) if and only if the lesion is near the optic chiasm (OC). NF microincidentaloma of less than 5mm requires no surveillance; those of≥5mm are not operated on but rather monitored on MRI at 6months and then 2years. Macroincidentaloma remote from the OC is monitored on MRI at 1year, with hormonal exploration (for anterior pituitary deficiency), then every 2years. When macroincidentaloma located near the OC is managed by surveillance rather than surgery, MRI is recommended at 6months, with hormonal and visual exploration, then annual MRI and hormonal and visual assessment every 6months. Surgery is indicated in the following cases: evolutive NF microincidentaloma, NF macroincidentaloma associated with hypopituitarism or showing progression, incidentaloma compressing the OC, possible malignancy, non-compliant patient, pregnancy desired in the short-term, or context at risk of apoplexy.

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“…63 In studies without iMRI use, the incidence of postoperative ophthalmological symptoms worsening was reported to range from 0% to 4%. 7,21,39,47 Nevertheless, due to patient and tumor characteristic variations, a direct comparison is prone to be biased.…”

Section: 21mentioning

confidence: 99%

Intraoperative high-field MRI for transsphenoidal reoperations of nonfunctioning pituitary adenoma

Berkmann

Schlaffer

Nimsky

et al. 2014

JNS

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Object. The loss of anatomical landmarks, frequently invasive tumor growth, and tissue changes make transsphenoidal reoperation of nonfunctioning pituitary adenomas (NFAs) challenging. The use of intraoperative MRI (iMRI) may lead to improved results. The goal of this retrospective study was to evaluate the impact of iMRI on transsphenoidal reoperations for NFA.Methods. Between September 2002 and July 2012, 109 patients underwent reoperations in which 111 transsphenoidal procedures were performed and are represented in this study. A 1.5-T Magnetom Sonata Maestro Class scanner (Siemens) was used for iMRI. Follow-up iMRI scans were acquired if gross-total resection (GTR) was suspected or if no further removal seemed possible.Results. Surgery was performed for tumor persistence and regrowth in 26 (23%) and 85 (77%) patients, respectively. On the initial iMRI scans, GTR was confirmed in 19 (17%) patients. Remnants were located as follows: 65 in the cavernous sinus (71%), 35 in the suprasellar space (38%), 9 in the retrosellar space (10%). Additional resection was possible in 62 (67%) patients, resulting in a significant volume reduction and increased GTR rate (49%). The GTR rates of invasive tumors on initial iMRI and postoperative MRI (poMRI) were 7% and 25%, respectively. Additional remnant resection was possible in 64% of the patients. Noninvasive tumors were shown to be totally resected on the initial iMRI in 31% of cases. After additional resection for 69% of the procedures, the GTR rate on poMRI was 75%. Transcranial surgery to resect tumor remnants was indicated in 5 (5%), and radiotherapy was performed in 29 (27%) patients. After GTR, no recurrence was detected during a mean follow-up of 2.2 ± 2.1 years.Conclusions. The use of iMRI in transsphenoidal reoperations for NFA leads to significantly higher GTR rates. It thus prevents additional operations and reduces the number of tumor remnants. The complication rates do not exceed the incidences reported in the literature for primary transsphenoidal surgery. If complete tumor resection is not possible, iMRI guidance can facilitate tumor volume reduction. (http://thejns.org/doi/abs/10.3171/2014.6.JNS131994) key WorDS • pituitary adenoma • intraoperative MRI • reoperation • tumor recurrence • transsphenoidal surgery • pituitary surgeryAbbreviations used in this paper: DI = diabetes insipidus; FSH = follicle-stimulating hormone; GKS = Gamma Knife surgery; GTR = gross-total resection; iMRI = intraoperative MRI; LH = luteinizing hormone; NFA = nonfunctioning pituitary adenoma; poMRI = postoperative MRI; VA = visual acuity; VF = visual field. J Neurosurg / Volume 121 / November 2014Intraoperative MRI for transsphenoidal reoperations 1167 ly.29 Nevertheless, the benefit of iMRI for the growing number of patients in need of repeat surgery remains unclear. The aim of this retrospective study was to evaluate the impact of iMRI on the extent of transsphenoidal reoperations in patients presenting with recurrent or persisting NFA. Methods Patient Population and Data Asse...

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Outcomes of surgical treatment for nonfunctioning pituitary adenomas: a systematic review and meta‐analysis

Abstract: Observational evidence supports the association between a combined approach of transsphenoidal surgery with radiotherapy and improvements in visual field defects and reduction in tumour recurrence.

Cited by 121 publications

References 53 publications

Is positive staining of nonfunctioning pituitary adenomas for luteinizing hormone associated with poor prognosis?

Is positive staining of nonfunctioning pituitary adenomas for luteinizing hormone associated with poor prognosis?

Management of nonfunctioning pituitary incidentaloma

Intraoperative high-field MRI for transsphenoidal reoperations of nonfunctioning pituitary adenoma

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