Three-dimensional volumetric measurements in defining endoscope-guided giant adenoma surgery outcomes

Chohan, Muhammad Omar; Levin, Aaron; Singh, Ranjodh; Zhou, Zhiping; Green, Carlos L.; Kazam, J. Jacob; Tsiouris, Apostolos John; Anand, Vijay K.; Schwartz, Theodore H.

doi:10.1007/s11102-016-0709-2

Cited by 53 publications

(32 citation statements)

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“…Seven studies included only non-functioning pituitary adenoma patients [ 28 , 31 , 33 , 37 , 40 , 42 , 46 ]. Gross total resection grades were reported in 26 studies and ranged between 14 and 91% (median: 63.5%) (Table 1 ) [ 5 , 6 , 8 , 11 , 20 , 21 , 24 – 26 , 28 – 34 , 36 – 40 , 42 , 43 , 46 , 47 ].…”

Section: Resultsmentioning

confidence: 99%

Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis

et al. 2017

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PurposePatients with pituitary adenomas often present with visual deficits. While the aim of endoscopic endonasal transsphenoidal surgery (EETS) is to improve these deficits, permanent worsening is a possible outcome. The aim of this meta-analysis was to evaluate the effect of EETS for pituitary adenomas on visual outcomes.MethodsA meta-analysis was conducted according to the PRISMA guidelines. Pooled prevalence was calculated for complete recovery, improvement, and deterioration of visual field deficits, visual acuity and unspecified visual function in fixed- and random-effect models, including assessment of heterogeneity (I2) and publication bias (Begg’s test).ResultsOut of 2636 articles, 35 case series were included in the meta-analysis. Results are described for fixed-effect models. For patients with impaired visual acuity, only one study reported complete recovery (27.2%). Pooled prevalence for improvement was 67.5% (95% CI = 59.1–75.0%), but with considerable heterogeneity (I2: 86.0%), and 4.50% (95% CI = 1.80–10.8%) for patients experiencing deterioration. For patients with visual field deficits, the prevalence was 40.4% (95% CI = 34.8–46.3%) for complete recovery, 80.8% (95% CI = 77.7–83.6%) for improvement, and 2.3% (95% CI = 1.1–4.7%) for deterioration. For the unspecified visual outcomes, pooled prevalence of complete recovery was 32.9% (95% CI: 28.5–37.7%), but with considerable heterogeneity (I2 = 84.2%). The prevalence was 80.9% (95% CI = 77.9–83.6) for improvement and 2.00% (95% CI = 1.10–3.40%) for deterioration. Random-effect models yielded similar results. Publication bias was non-significant for all the outcomes.ConclusionWhile visual deficits improved after EETS in the majority of patients, complete recovery was only achieved in less than half of the patients and some patients even suffered from visual deterioration.Electronic supplementary materialThe online version of this article (doi:10.1007/s11102-017-0815-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis

et al. 2017

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“…Preoperative radiological diagnosis of CSI plays a crucial role in establishing prognosis and the therapeutic plan. Although we cannot exclude that even an adenoma with Knosp grade ≤ 2 may be invasive [115], pituitary tumors with Knosp grades 3B-4 are characterised by subtotal surgical resection, low biochemical remission rate [10,11,111,[116][117][118][119][120][121], need for complementary therapies, and a higher risk of recurrence [84]. However, radiology does not always allow discriminating between compression/extension and invasion of CS, and it might therefore overestimate CS invasion.…”

Section: Radiological Criteria and Classificationsmentioning

confidence: 99%

Pituitary Adenomas and Invasiveness from Anatomo-Surgical, Radiological, and Histological Perspectives: A Systematic Literature Review

Serioli

Doglietto

Fiorindi

et al. 2019

Cancers

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Invasiveness in pituitary adenomas has been defined and investigated from multiple perspectives, with varying results when its predictive value is considered. A systematic literature review, following PRISMA guidelines, was performed, searching PubMed and Scopus databases with terms that included molecular markers, histological, radiological, anatomical and surgical data on invasiveness of pituitary adenomas. The results showed that differing views are still present for anatomical aspects of the sellar region that are relevant to the concept of invasiveness; radiological and histological diagnoses are still limited, but might improve in the future, especially if they are related to surgical findings, which have become more accurate thanks to the introduction of the endoscope. The aim is to achieve a correct distinction between truly invasive pituitary adenomas from those that, in contrast, present with extension in the parasellar area through natural pathways. At present, diagnosis of invasiveness should be based on a comprehensive analysis of radiological, intra-operative and histological findings.

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“…In a prior study we have shown that using an ellipsoid model overestimates the volume of the tumor by roughly 16%. 12 This error is worse for tumors > 40 cm 3 , of which there was only one case in this study. However, our prior study shows that the ellipsoid model, while not perfect, provides a good approximation of the volume of the tumor.…”

Section: Limitationsmentioning

confidence: 58%

Reoperative endoscopic endonasal surgery for residual or recurrent pituitary adenomas

Negm

Al-Mahfoudh

Pai

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Regrowth of the lesion after surgical removal of pituitary adenomas is uncommon unless subtotal resection was originally achieved in the first surgery. Treatment for recurrent tumor can involve surgery or radiotherapy. Locations of residual tumor may vary based on the original approach. The authors evaluated the specific sites of residual or recurrent tumor after different transsphenoidal approaches and describe the surgical outcome of endoscopic endonasal transsphenoidal reoperation. METHODS The authors analyzed a prospectively collected database of a consecutive series of patients who had undergone endoscopic endonasal surgeries for residual or recurrent pituitary adenomas after an original transsphenoidal microscopic or endoscopic surgery. The site of the recurrent tumor and outcome after reoperation were noted and correlated with the primary surgical approach. The chi-square or Fisher exact test was used to compare categorical variables, and the Mann-Whitney U-test was used to compare continuous variables between surgical groups. RESULTS Forty-one patients underwent surgery for residual/recurrent pituitary adenoma from 2004 to 2015 at Weill Cornell Medical College. The previous treatment was a transsphenoidal microscopic (n = 22) and endoscopic endonasal (n = 19) surgery. In 83.3% patients (n = 30/36) there was postoperative residual tumor after the initial surgery. A residual tumor following endonasal endoscopic surgery was less common in the sphenoid sinus (10.5%; 2/19) than it was after microscopic transsphenoidal surgery (72.7%; n =16/22; p = 0.004). Gross-total resection (GTR) was achieved in 58.5%, and either GTR or near-total resection was achieved in 92.7%. Across all cases, the average extent of resection was 93.7%. The rate of GTR was lower in patients with Knosp-Steiner Grade 3-4 invasion (p< 0.0005). Postoperative CSF leak was seen in only one case (2.4%), which stopped with lumbar drainage. Visual fields improved in 52.9% (n = 9/17) of patients and were stable in 47% (n = 8/17). Endocrine remission was achieved in 77.8% (n = 14/18) of cases, 12 by surgery alone and 2 by adjuvant medical (n = 1) and radiation (n = 1) therapy. New diabetes insipidus occurred in 4.9% (n = 2/41) of patients-in one of whom an additional single anterior hormonal axis was compromised-and 9.7% (n = 4/41) of patients had a new anterior pituitary hormonal insufficiency. CONCLUSIONS Endonasal endoscopic reoperation is extremely effective at removing recurrent or residual pituitary adenomas that remain after a prior surgery, and it may be preferable to radiation therapy particularly in symptomatic patients. Achievement of GTR is less common when lateral cavernous sinus invasion is present. The locations of residual/recurrent tumor were more likely sphenoidal and parasellar following a prior microscopic transsphenoidal surgery and sellar following a prior endonasal endoscopic surgery.

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Three-dimensional volumetric measurements in defining endoscope-guided giant adenoma surgery outcomes

Abstract: We propose a new volumetric threshold of 20 cm(3) as most accurate for predicting GTR in the EEA era. CC measurement is the least useful predictor. Cavernous sinus invasion remains the best predictor of incomplete resection.

Cited by 53 publications

References 39 publications

Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis

Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis

Pituitary Adenomas and Invasiveness from Anatomo-Surgical, Radiological, and Histological Perspectives: A Systematic Literature Review

Reoperative endoscopic endonasal surgery for residual or recurrent pituitary adenomas

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