Time to Revive the Value of the Pseudocapsule in Endoscopic Endonasal Transsphenoidal Surgery for Growth Hormone Adenomas

Xie, Tao; Liu, Tengfei; Zhang, Xiaobiao; Chen, Lingli; Luo, Rongkui; Sun, Wei; Hu, Fan; Gu, Yajia; Lu, Zhiqiang

doi:10.1016/j.wneu.2016.01.036

Cited by 23 publications

(22 citation statements)

References 20 publications

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“…The high rate of detectable pseudocapsules led to a high rate of extrapseudocapsular resections. In our series, the rate of complete extrapseudocapsular resections (49/143, 34.3%) was higher than that in previous research (8.2%-23.8%) [6,7,10] and in Group A, all patients had achieved GTR and hormone remission. This result was the same as Xie et al [7] and Kim et al [10].…”

Section: Detectable Rate Of Pseudocapsule and Extent Of Resectioncontrasting

confidence: 71%

“…In our series, the rate of complete extrapseudocapsular resections (49/143, 34.3%) was higher than that in previous research (8.2%-23.8%) [6,7,10] and in Group A, all patients had achieved GTR and hormone remission. This result was the same as Xie et al [7] and Kim et al [10]. However, there were no differences in the GTR (76.8% vs 73.8%, p=0.435) and hormone remission rate (80.8% vs 71.4%, p=0.685) between Group B and Group C. The ETSS approach also improved the GTR in piecemeal resection [24], and we performed a more active piecemeal resection would rather resect part of the compressed pituitary gland than completely remove the adenoma [25].…”

Section: Detectable Rate Of Pseudocapsule and Extent Of Resectioncontrasting

confidence: 71%

“…Regarding surgical technology, previous studies [3][4][5][6][7][8] have mainly used the surgical technology summarized by Old eld on the basis of the microscopic transseptal transsphenoidal approach (MTSS), which is more suitable for microadenomas or small macroadenomas [7]. For surgery involving larger adenomas, it is hard to distinguish the pseudocapsule from the anterior surface of the adenoma, which limits the application of extrapseudocapsular resection [9].…”

Section: Introductionmentioning

confidence: 99%

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Endonasal Endoscopic Surgery for Macroadenomas: New Understanding of Pseudocapsules

Zheng

et al. 2021

Preprint

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PurposeExtracapsular resection of pituitary microadenomas has been widely reported, but only a few studies have carried out further investigations in macroadenomas, especially using the endonasal endoscopic approach. The authors of this study combined not only the interoperative characteristics of pituitary adenomas and pseudocapsules but also the surgical technique, outcomes and complications in macroadenomas to investigate the pseudocapsule.MethodsIn total, 143 consecutive patients with pituitary adenomas (maximum diameter 15 - 40 mm) who underwent endoscopic endonasal-transsphenoidal surgery between January 1, 2017, and August 1, 2019, were included in the study. ResultsAmong 143 patients, 48 patients had an intact pseudocapsule, 56 patients possessed an incomplete pseudocapsule and the remaining 38 patients had no pseudocapsule. A white and thick pseudocapsule was more frequent (p=0.016) in fibrous adenomas, but tumor fibrosis (p=0.004) and adenoma apoplexy (p<0.001) were the factors that predicted the pseudocapsular integrity and hindered en bloc extracapsular resection according to a logistic regression analysis. In addition, the adenoma size (p=0.185) did not influence pseudocapsular integrity. Partial capsulectomy for macroadenomas did not show a significant advantage over piecemeal resection in gross total tumor resection (GTR) or biochemical remission (p=0.731 and p=0.685, respectively), but GTR in whole capsular resection was 100%. Additionally, this resection method had a higher risk of intraoperative cerebrospinal fluid leakage (p=0.010) and a lower incidence of new hormone deficit (p=0.043) than piecemeal resection.ConclusionsThe pseudocapsule widely exists in pituitary macroadenomas and extracapsular resection can improve GTR and hormone remission rate and reduce the occurrence of postoperative pituitary dysfunction in short-time.

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Section: Detectable Rate Of Pseudocapsule and Extent Of Resectioncontrasting

confidence: 71%

Section: Detectable Rate Of Pseudocapsule and Extent Of Resectioncontrasting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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Endonasal Endoscopic Surgery for Macroadenomas: New Understanding of Pseudocapsules

Zheng

et al. 2021

Preprint

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“…2017; 4(3):e14131. 5 ies using the 2010 criteria with the reported remission rates of 28.8% to 70.8% (7,19,(26)(27)(28)(29)(30)(31)(32)(33). The current study results showed an overall remission rate of 71.4% with the mean follow-up of 25.4 months.…”

Section: Discussionsupporting

confidence: 51%

Endoscopic Transsphenoidal Approach for Surgical Treatment of Growth Hormone Secreting Pituitary Adenoma: Endocrinological Outcome in 49 Patients Based on 2010 Consensus Criteria for Remission - Preliminary Result

et al. 2017

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Background: Nowadays, the endoscopic transsphenoidal approach is the initial option for resection of all pituitary adenomas. The current study reported the experience with endoscopic transsphenoidal surgery remission rates using the 2010 consensus criteria, predictors of remission, and the associated complications. Methods: A prospectively collected database of 49 patients with acromegaly who underwent endoscopic endonasal transsphenoidal surgery was analyzed. Tumors were classified according to size, as well as the Knosp and the Hardy-Wilson classifications. Endocrinological remission was defined as normal insulin-like growth factor (IGF)-I level and either a suppressed growth hormone (GH) level < 0.4 ng/mL during an oral glucose tolerance test, or a random GH level < 1.0 ng/mL at least 3 months after the surgery. The extent of resection was evaluated on postoperative contrast-enhanced magnetic resonance imaging (MRI). Results: Biochemical remission was achieved in 7 of 9 (77.8%) microadenoma and 28 of 40 (70%) macroadenoma. The total remission rate was 71.4% and gross total resection was achieved in 45 of 49 (91.8%) patients. Tumor size, age, gender, history of prior surgery, suprasellar extension, and sphenoid sinus invasion were not associated with remission rate. Preoperative variables predictive of remission included the Knosp score (P = 0.041) and GH levels (P = 0.047). Two patients (4.1%) experienced postoperative pan hypopituitarism, and permanent DI was observed in 3 (6.1%) patients. One patient (2%) had cerebrospinal fluid (CSF) leaks treated with serial lumbar punctures. The median follow-up period was 25.45 months; ranged from 3 to 49. Conclusions: Endoscopic transsphenoidal adenoma resection leads to a high rate of endocrinological remission in patients with low acromegaly complication. Patients with high preoperative GH levels and the Knosp scores are less likely to achieve remission.

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“…Xie et al . analyzed retrospective data from 2 time periods, when the authors attempted an intracapsular approach and when the authors attempted an extracapsular approach for GH‐secreting pituitary adenomas.…”

Section: Intradural Tumorsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

143

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Time to Revive the Value of the Pseudocapsule in Endoscopic Endonasal Transsphenoidal Surgery for Growth Hormone Adenomas

Cited by 23 publications

References 20 publications

Endonasal Endoscopic Surgery for Macroadenomas: New Understanding of Pseudocapsules

Endonasal Endoscopic Surgery for Macroadenomas: New Understanding of Pseudocapsules

Endoscopic Transsphenoidal Approach for Surgical Treatment of Growth Hormone Secreting Pituitary Adenoma: Endocrinological Outcome in 49 Patients Based on 2010 Consensus Criteria for Remission - Preliminary Result

ICAR: endoscopic skull‐base surgery

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