What is the current clinical practice in pituitary adenoma surgery in Europe? European Pituitary Adenoma Surgery Survey (EU-PASS) results—technical part

Májovský, Martin; Grotenhuis, André; Foroglou, Nicolas; Zenga, Francesco; Froehlich, Sébastien; Ringel, Florian; Samprón, Nicolás; Thomas, Nick; Komarc, Martin; Netuka, David

doi:10.1007/s10143-021-01614-1

Cited by 8 publications

(9 citation statements)

References 43 publications

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“…poses a significant risk for thromboembolic complications. In accordance with other European countries [10], the use of intraoperative MRI and CT is only reported by a minority of centers (10 %) in Germany. Although intraoperative MRI is available in only a few centers its use in pituitary surgery, especially in small adenomas is controversial.…”

Section: Discussionsupporting

confidence: 83%

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Pituitary Surgery in Germany – Findings from the European Pituitary Adenoma Surgery Survey

Ottenhausen

Conrad

Kalasauskas

et al. 2023

Exp Clin Endocrinol Diabetes

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Background Surgery is, next to medical and radiation therapy, the mainstay therapy for pituitary adenomas. While scientific consensus regarding the key aspects of pituitary surgery exists among neurosurgeons, procedures are not standardized and might vary significantly between hospitals and surgeons. Objective Providing an overview of how neurosurgical departments in Germany manage pituitary surgery. Methods Responses from the European Pituitary Adenoma Surgery Survey (EU-PASS) were analyzed. The survey contained 60 questions regarding demographics, training, surgical aspects, endocrinological aspects and patient management. Results 60 neurosurgical centers from Germany responded to the survey. 35.3% (n=18) of centers exclusively use the microscopic and 31.1% (n=14) the endoscopic technique exclusively, all other centers (n=28) use both approaches. 20% (n=12) of responding centers perform less than 10 transsphenoidal pituitary surgeries per year and 1,7% (n=1) more than 100 operations. The number of transcranial pituitary operations is significantly smaller 53,3% of centers performing only 0-2 per year, 35% performing 3-5 and only one center (1,7%) performing more than 15 transcranial operations per year. In 8 centers (13,3%) surgeries are always performed together with an ENT surgeon, in 29 center (48,4%) ENT surgeons are never involved. . In most centers (n=54, 90%) intraoperative MRI is not available. Image guidance (with preoperative CT and/or MRI data) is used by 91.7% of respondents (n=55). 42 centers (72.4%) prescribe hydrocortisone after pituitary surgery routinely. 75% (n=45) have pituitary board meetings with endocrinologists, radiologists and radiosurgeons. 52 (86.7%) respondents perform the first follow-up scan by MRI 3-4 months after surgery. Conclusions The data showed differences as well as similarities between centers and could help to discuss standardization of methods as well as the formation of networks and certification to improve patient care.

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Section: Discussionsupporting

confidence: 83%

“…Here, we present data analysis from an online Europe-wide European Pituitary Adenoma Surgery survey (EUPASS) 10 11 12 to obtain a detailed overview of the current practice of pituitary surgery among neurosurgical departments in Germany.…”

Section: Introductionmentioning

confidence: 99%

Pituitary Surgery in Germany – Findings from the European Pituitary Adenoma Surgery Survey

Ottenhausen

Conrad

Kalasauskas

et al. 2023

Exp Clin Endocrinol Diabetes

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“…The study period started on 1 April 2019 and closed on 30 June 2019. The remaining sections were covered in previous papers 1 , 2 . All questions used in survey are presented as supplementary data .…”

Section: Methodsmentioning

confidence: 99%

Endocrinological aspects of pituitary adenoma surgery in Europe

Netuka

Grotenhuis

Foroglou

et al. 2022

Sci Rep

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Hormone-secreting adenomas are treated in many neurosurgical centers within Europe. The goal of the survey is to understand variance in practice management of pituitary tumors amongst neurosurgical centers. A list of departments performing pituitary surgery was created. The survey consisted of 58 questions. This study focuses on neurosurgical care of hormone-secreting adenomas. For analysis, the departments were divided into four subgroups: academic/non-academic, high-volume/low-volume, “mainly endoscopic/mainly microscopic practice” and geographical regions. Data from 254 departments from 34 countries were obtained. Most centers surgically treat 1–5 hormone-secreting adenomas per year. In prolactinomas this is the case in 194 centers, (76.4%), in GH-secreting adenomas: 133 centers, (52.4%), ACTH-secreting adenomas: 172 centers, (69.8%). Surgery as a primary treatment of prolactinomas is considered in 64 centers (25.2%). In 47 centers (18.8%), GH-secreting microadenomas are often treated pharmacologically first. Debulking surgery for an invasive GH-secreting adenoma in which hormonal remission is not a realistic goal of the surgery and the patient has no visual deficit surgery is always or mostly indicated in 156 centers (62.9%). Routine postoperative hydrocortisone replacement therapy is administered in 147 centers (58.6%). Our survey shows that in most centers, few hormone-secreting adenomas are treated per year. In about 25% of the centers, prolactinoma surgery may be regarded as first-line treatment; in about 20% of the centers, medical treatment is the first-line treatment for GH-secreting adenomas. Pretreatment for ACTH-secreting adenomas is routinely used in 21% of centers. This survey may serve as plea for neurosurgical care centralization of hormone-secreting adenomas.

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“…However, there is no standard surgical technique. 9 A variety of methods for sellar and dural reconstruction have been described in which either autologous 10,11 or synthetic tissue is used. [12][13][14] The use of fascia lata, nasoseptal flaps, or the transplantation of paraumbilical fat have been reported to reduce pCSF leaks, 10,15 but they carry the risk of side effects and complications such as postoperative hematomas, pain or infections in the area of the graft, cosmetically unappealing abdominal and thigh scars, or anosmia.…”

mentioning

confidence: 99%

“…2,16,17 A recent survey by Májovský et al found that many neurosurgeons continue to use autologous material for sellar closure despite such potential complications. 9 For many years we have been using a standardized technique for iCSF leak repair and sellar closure in which artificial material is used. Here, we revisited our technique and the surgical results in terms of the number of iCSF leaks, pCSF leaks, and CNS infections to challenge the more invasive methods with autologous material described above.…”

mentioning

confidence: 99%

A simple surgical technique for sellar closure after transsphenoidal resection of pituitary adenomas in the context of risk factors for cerebrospinal fluid leaks and meningitis

Ueberschaer

Katzendobler

Biczok

et al. 2022

Neurosurgical Focus

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OBJECTIVE The transsphenoidal approach is the standard for most pituitary tumors. Despite low morbidity, postoperative CSF fistulas and meningitis are specific complications. Various surgical closure techniques for intraoperative CSF (iCSF) leak and sellar reconstruction have been described. For many years the authors have applied synthetic materials for iCSF leak repair and sellar closure in a standardized fashion in their department. Here they analyze the surgical outcome as well as risk factors for iCSF leak and meningitis. METHODS All patients with transsphenoidal resection of a pituitary adenoma performed by the same surgeon between January 2013 and December 2019 were screened retrospectively. A small amount of iCSF flow without a diaphragmatic defect was classified as a minor leak, and obvious CSF flow with or without a diaphragmatic defect was classified as a major leak. In case of iCSF leak, a fibrin- and thrombin-coated sponge was used to cover the diaphragmatic defect and another one was used for the sellar opening. A gelatin sponge was placed in the sphenoid sinus as an abutment. The primary and secondary outcomes were the number of postoperative CSF (pCSF) leaks and meningitis, respectively. Clinical, histological, and perioperative data from medical records were collected to identify risk factors for CSF leak and meningitis. RESULTS Of 417 transsphenoidal surgeries, 359 procedures in 348 patients with a median age of 54 years were included. There were 96 iCSF leaks (26.7%; 37.5% major, 62.5% minor). In 3 of 359 cases (0.8%) a pCSF fistula occurred, requiring revision surgery in 2 patients and a lumbar drain in 1 patient. Meningitis occurred in 3 of 359 cases (0.8%). All 3 patients recovered without sequelae after antibiotic therapy. According to univariate analysis, risk factors for iCSF leak were macroadenoma (p = 0.006) and recurrent adenoma (p = 0.032). An iCSF leak was found less often in functioning adenomas (p = 0.025). In multivariate analysis recurrent tumors remained as a risk factor (p = 0.021) for iCSF leak. Patients with iCSF leak were at increased risk for a pCSF leak (p = 0.005). A pCSF leak in turn represented the key risk factor for meningitis (p = 0.033). CONCLUSIONS Patients with macroadenomas and recurrent adenomas are especially at risk for iCSF leak. An iCSF leak in turn increases the risk for a pCSF leak, which carries the risk for meningitis. The authors’ surgical technique leads to a very low rate of pCSF leaks and meningitis without using autologous graft materials. Hence, this technique is safe and improves patient comfort by avoiding the disadvantages of autologous graft harvesting.

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What is the current clinical practice in pituitary adenoma surgery in Europe? European Pituitary Adenoma Surgery Survey (EU-PASS) results—technical part

Cited by 8 publications

References 43 publications

Pituitary Surgery in Germany – Findings from the European Pituitary Adenoma Surgery Survey

Pituitary Surgery in Germany – Findings from the European Pituitary Adenoma Surgery Survey

Endocrinological aspects of pituitary adenoma surgery in Europe

A simple surgical technique for sellar closure after transsphenoidal resection of pituitary adenomas in the context of risk factors for cerebrospinal fluid leaks and meningitis

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