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

Araujo-Castro, Marta; Cancela, Alberto Acitores; Vior, Carlos; Pascual‐Corrales, Eider; Berrocal, Víctor Rodríguez

doi:10.3389/fonc.2021.807040

Cited by 28 publications

(16 citation statements)

References 52 publications

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“…The Knosp classification scheme for cavernous sinus invasion by pituitary lesions is an example of an attempt to create clinically meaningful categories of anatomical involvement, which has been shown to be related to the extent of surgical resection achieved 27 . Table 3 lists common skull base lesions and the anatomical classification scales that attempt to describe them with concise uniform scoring systems.…”

Section: Building Consensusmentioning

confidence: 99%

Skull Base Registries: A Roadmap

Parikh

Motiwala

Furlan

et al. 2022

J Neurol Surg B Skull Base

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Hospitals, payors and patients increasingly expect us to report our outcomes in more detail and to justify our treatment decisions and costs. Although there are many stakeholders in surgical outcomes, physicians must take the lead role in defining how outcomes are assessed. Skull base lesions interact with surrounding anatomy to produce a complex spectrum of presentations and surgical challenges, requiring a wide variety of surgical approaches. Moreover, many skull base lesions are relatively rare. These factors and others often preclude the use of prospective randomized clinical trials, thus necessitating alternate methods of scientific inquiry. In this paper we propose a roadmap for implementing a skull base registry, along with expected benefits and challenges.

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Section: Building Consensusmentioning

confidence: 99%

Skull Base Registries: A Roadmap

Parikh

Motiwala

Furlan

et al. 2022

J Neurol Surg B Skull Base

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“…Marta et al. reported that Knosp and revised-Knosp classification showed good diagnostic accuracy in predicting surgical cure (AUC, 0.820), whereas Hardy classification lacked practicality in this purpose (AUC, 0.654) ( 22 ), which may indicate that the main prognostic factor was CSI ( 24 ). In an 8-year, retrospective, multicenter, cohort study that included 410 patients, Trouillas et al.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of a Prognostic Model for Post-Operative Recurrence of Pituitary Adenomas

Lü

Wan

et al. 2022

Front. Oncol.

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BackgroundWe aimed to assess clinical factors associated with tumor recurrence and build a nomogram based on identified risk factors to predict postoperative recurrence in patients with pituitary adenomas (PAs) who underwent gross-total resection (GTR).MethodsA total of 829 patients with PAs who achieved GTR at Tongji Hospital between January 2013 and December 2018 were included in this retrospective study. The median follow-up time was 66.7 months (range: 15.6–106.3 months). Patients were randomly divided into training (n = 553) or validation (n = 276) cohorts. A range of clinical characteristics, radiological findings, and laboratory data were collected. Uni- and multivariate Cox regression analyses were applied to determine the potential risk factors for PA recurrence. A nomogram model was built from the identified factors to predict recurrence. Concordance index (C-index), calibration curve, and receiver operating characteristic (ROC) were used to determine the predictive accuracy of the nomogram. Decision curve analysis (DCA) was performed to evaluate the clinical efficacy of the nomogram.ResultsPseudocapsule-based extracapsular resection (ER), cavernous sinus invasion (CSI), and tumor size were included in the nomogram. C-indices of the nomogram were 0.776 (95% confidence interval [CI]: 0.747–0.806) and 0.714 (95% CI: 0.681–0.747) for the training and validation cohorts, respectively. The area under the curve (AUC) of the nomogram was 0.770, 0.774, and 0.818 for 4-, 6-, 8-year progression-free survival (PFS) probabilities in the training cohort, respectively, and 0.739, 0.715 and 0.740 for 4-, 6-, 8-year PFS probabilities in the validation cohort, respectively. Calibration curves were well-fitted in both training and validation cohorts. DCA revealed that the nomogram model improved the prediction of PFS in both cohorts.ConclusionsPseudocapsule-based ER, CSI, and tumor size were identified as independent predictors of PA recurrence. In the present study, we developed a novel and valid nomogram with potential utility as a tool for predicting postoperative PA recurrence. The use of the nonogram model can facilitate the tailoring of counseling to meet the individual needs of patients.

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“…Knosp grade can reflect parasellar extension of the tumor. The Hardy–Wilson classification ( 10 ) was used for the assessment of suprasellar extension grades and sellar floor erosion grades ( Figures 2 , 3 ). It is important to point out that since Hardy D and E grades reflect parasellar extension, we only used Hardy 0–C grades for the evaluation of suprasellar extension grade.…”

Section: Methodsmentioning

confidence: 99%

Risk factors and management associated with postoperative cerebrospinal fluid leak after endoscopic endonasal surgery for pituitary adenoma

Zhao

Fang

et al. 2022

Front. Surg.

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ObjectiveTo determine risk factors and management for the development of a postoperative cerebrospinal fluid (CSF) leak after an endoscopic endonasal surgery (EES) for pituitary adenomas.MethodsThe clinical data of 400 patients who underwent EES for resection of pituitary adenomas from December 2018 to November 2019 in the Department of Neurosurgery of Beijing Tiantan Hospital were retrospectively reviewed. Age, gender, body mass index (BMI), tumor size, Knosp grade, suprasellar extension grade, sellar floor erosion grade, repeated transsphenoidal surgery, intraoperative CSF leak, use of pedicled nasoseptal flap and lumbar drain were collected and analyzed.ResultsPostoperative CSF leak occurred in 14 of 400 patients (3.5%). Age, gender, BMI, tumor size, Knosp grade and repeated transsphenoidal surgery were not risk factors for CSF leak. Suprasellar extension grade (≥B 6.0% vs. <B 1.4%; p = 0.024), sellar floor erosion grade (≥III 5.7% vs. <III 0.6%; p = 0.020) and intraoperative CSF leak (Yes 7.5% vs. No 2.0%; p = 0.009) were factors associated with an increased postoperative CSF leak rate.ConclusionsHigher suprasellar extension grade, higher sellar floor erosion grade and intraoperative CSF leak were risk factors for postoperative CSF leak after endoscopic treatment of pituitary adenoma. Strict skull base reconstruction including use of a pedicled nasoseptal flap and perioperative lumbar drainage may avoid postoperative CSF leak.

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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

Cited by 28 publications

References 52 publications

Skull Base Registries: A Roadmap

Skull Base Registries: A Roadmap

Development and Validation of a Prognostic Model for Post-Operative Recurrence of Pituitary Adenomas

Risk factors and management associated with postoperative cerebrospinal fluid leak after endoscopic endonasal surgery for pituitary adenoma

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