Transsphenoidal microsurgical management of pituitary adenomas

Yang, Shu‐Yuan; Zhu, Tong; Zhang, Jian‐Ning; Sun, Yin‐Shui

doi:10.1002/micr.1920151103

Cited by 14 publications

(9 citation statements)

References 26 publications

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“…In NFA, age [40, 44, 51, 54, 55, 57, 61, 63, 143], gender [40, 44, 45, 51, 54, 57, 61, 63, 143], tumor size [40, 44, 51, 54, 55, 57, 61, 63, 143], and tumor invasion had prognostic significance in some studies[40, 41, 64], but not in others [51, 54, 57, 63]. Histology was a predictor in some studies [40, 43, 47, 57, 58], but not in others [54, 61, 64, 143].…”

Section: Resultsmentioning

confidence: 99%

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Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis

2011

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To study the currently available data of recurrence rates of functioning and nonfunctioning pituitary adenomas following surgical cure and to analyze associated predisposing factors, which are not well established. A systematic literature search was conducted using Medline, Embase, Web of Science and the Cochran Library for studies reporting data on recurrence of pituitary adenoma after surgery, in nonfunctioning adenoma (NF), prolactinoma (PRL) acromegaly (ACRO) and Cushing’s disease (CUSH). Of 557 initially retrieved potential relevant studies 143 were selected. Recurrence in NFA was defined as reappearance of tumor on MRI or CT. Increase of hormone levels above normal limits as set by the authors after initial remission was used to indicate recurrence in the functioning tumor types. Remission percentage was lowest in NFA compared with other tumor types (P < 0.001). Surgery-related hypopituitarism was more frequent in CUSH than in the other tumors (P < 0.001). Recurrence, expressed as percentage of the cured population or as ratio of recurrence and total patient years of follow-up was highest in PRL (P < 0.001). The remission percentage did not improve over 3 decades of publications, but there was a modest decrease in recurrence rate (P = 0.04). Recurrences peaked between 1 and 5 years after surgery. Most of the studies with a sufficient number of recurrences did not apply multivariate statistics, and mentioned at best associated factors. Age, gender, tumor size and invasion were generally unrelated to recurrence. For functioning adenomas a low postoperative hormone concentration was a prognostically favorable factor. In NFA no specific factor predicted recurrence. Recurrence rate differs between pituitary adenomas, being highest in patients with prolactinoma, with the highest incidence of recurrence between 1 and 5 years after surgery in all adenomas. Patients with NFA have a lower chance of remission than patients with functioning adenomas. The postoperative basal hormone level is the most important predictor for recurrence in functioning adenomas, while in NFA no single convincing factor could be identified.

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Section: Resultsmentioning

confidence: 99%

“…Histology was a predictor in some studies [40, 43, 47, 57, 58], but not in others [54, 61, 64, 143]. …”

Section: Resultsmentioning

confidence: 99%

Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis

2011

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“…Comparison of the results for functioning adenomas revealed remission in 86% versus 81% of corticotropin-secreting adenomas, 89% versus 66% of PRLsecreting adenomas, and 85% versus 77% of growth hormonesecreting adenomas. [6][7][8][9][10][11][19][20][21][22][23][24][25][26] With a mean follow-up of 38.2 months, postoperative MRI for this endoscopic series revealed the remission rate for nonfunctioning adenomas to be 149 (93%) of 161 tumors. Two long-term reports documenting outcomes for nonfunctioning adenomas with an average of 72 months of follow-up noted an 82% remission rate (based on tumor recurrence).…”

Section: Tumor Remissionmentioning

confidence: 99%

“…This finding was first documented †Immediate or less than 1-year follow-up, postoperative remission rate (mean value) calculated from microscopic series. [6][7][8]11,24 ‡Immediate or less than 10-year follow-up, postoperative remission rate (mean value) calculated from microscopic series. 20,22,23,25,50 §Postoperative remission rate (mean value) calculated from microscopic series with an average of 72 months of follow-up (excluding patients who received postoperative radiation therapy).…”

Section: Tumor Remissionmentioning

confidence: 99%

Fully Endoscopic Transnasal Versus Transseptal Transphenoidal Pituitary Surgery

Kabil

Eby

Shahinian

2005

Neurosurgery Quarterly

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A long-term retrospective study was conducted of 300 patients who underwent fully endoscopic transnasal pituitary adenoma resection between November 1998 and October 2004. These patients' records and data from postoperative follow-up visits were used to ascertain their outcomes. The data were then compared with mean values calculated from several transseptal-transsphenoidal reports. Of a total of 300 pituitary adenomas, 139 (46%) were hormonally active, whereas 161 (54%) were nonfunctioning. The mean follow-up period was 38.2 months. The average length of hospital stay was 1.4 days. All patients had postoperative magnetic resonance imaging studies to assess residual or recurrent disease; all patients with hormonally active tumors had additional postoperative hormonal studies. Remission was defined as no hormonal or radiologic evidence of recurrence within the time frame of the follow-up period. Remission was demonstrated in 127 (95%) of 134 of enclosed adenomas and 144 (87%) of 166 of invasive adenomas. Comparison of fully endoscopic transnasal versus transseptal-transsphenoidal remission results revealed an improved outcome using the fully endoscopic transnasal technique: corticotropin-secreting (86% vs. 81%), prolactin-secreting (89% vs. 66%), and growth hormone-secreting (85% vs. 77%) adenomas. The remission rate for nonfunctioning adenomas was 149 (93%) of 161. Additionally, there was a marked reduction in complications related to this procedure. There have been few series to document the results of this procedure; the results of the current study conclude that the fully endoscopic transnasal technique is a safe and effective method for removal of pituitary adenomas, providing more complete tumor removal and reducing complications. This report presents the largest number of patients to date who have undergone fully endoscopic transnasal pituitary surgery and compares their outcomes with those published for the traditional transseptal-transsphenoidal method.

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“…The improved visualization allowed for more complete tumor removal, and reduced the incidence of complications. In the ensuing 40 years several large series have established the transsphenoidal approach as the procedure of choice for all but the most massive pituitary adenomas, demonstrating outcomes equivalent to or better than those reported for the transcranial procedure, with fewer complications 13,18,21,22,23,24,33,58,65,68,87,88,90,92 .…”

Section: Historical Recordsmentioning

confidence: 99%

Endoscopic Endonasal Approach to Pituitary Adenomas

Aguiar¹,

Laws²,

Dodd³

et al. 2018

jbnc

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Microscopic transsphenoidal surgery is beyond any doubt a widely accepted and highly effective therapy for pituitary adenomas. Currently several centers have converted to an endoscopic transsphenoidal approach; suggesting that this technique provides more complete tumor resection, better visualization and reduce complications. However, there have been few series to document the results of this procedure. This report presents the technical details and compares it to the results of the microscopic method based on the experience of the group and a literature review. The endoscopic transnasal/ transsphenoidal technique is a safe and effective method for removal of pituitary adenomas. The results found in the literature suggest that the endoscope provides more complete tumor removal, and reduces complications. We believe that the advantages of the endoscopic technique will allow this procedure to become the future gold standard surgical therapy for pituitary adenomas. SUMÁRIOA cirurgia trans-esfenoidal por meio de microscópio é sem dúvida um procedimento amplamente aceito e altamente efetivo no tratamento cirúrgico dos adenomas pituitários. Hoje em dia muitos centros tem modificado a via trans-esfenoidal endo-nasal, utilizando-se do endoscópio. Esta técnica tem demonstrado um maior índice de ressecção tumoral, uma visão melhor do leito cirúrgico, principalmente nos cantos e na margem junto ao seio cavernoso, e traz um menor índice de complicações. Os resultados da literatura têm demonstrado ser um procedimento seguro, e acreditamos que, devido às suas vantagens, se tornará uma conduta cirúrgica padrão ouro para os adenomas pituitários. Cirurgia pituitária, endoscopia, microcirurgia, acesso transesfenoidal. Palavras-chave:

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Transsphenoidal microsurgical management of pituitary adenomas

Cited by 14 publications

References 26 publications

Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis

Clinical factors involved in the recurrence of pituitary adenomas after surgical remission: a structured review and meta-analysis

Fully Endoscopic Transnasal Versus Transseptal Transphenoidal Pituitary Surgery

Endoscopic Endonasal Approach to Pituitary Adenomas

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