Classification of pituitary adenomas

Remission, complications, and overall survival in transsphenoidal pituitary surgery-a Swedish single-center experience of 578 patients

BACKGROUND

Surgical treatment of pituitary lesions causing hormonal overproduction or mass effect is standard procedure. There are few reports on the results and complications related to these surgeries from Northern Europe. Our aim was to evaluate the outcome and complications of a single tertiary surgical center over more than a decade.

METHODS

This was a retrospective study on all patients that underwent pituitary surgery from 1st of January 2005 to 31st of December 2017. The analysis included type of lesion, surgical method, pre- and postoperative need for hormonal substitution, hormonal outcome, complications to surgery, survival, need for revision surgery, or stereotactic radiation. Appropriate statistical analyses were made to evaluate surgical results, complications, and survival.

RESULTS

Five hundred seventy-eight patients were included in the study. Remission was achieved in 58% of patients with GH-producing and 94% of ACTH-releasing adenomas. Sixty-six percent had no preoperative hormonal substitution compared to 39% postoperatively. Rhinosinusitis (10%) was the most commonly reported postoperative complication followed by leakage of cerebrospinal fluid (8%) and meningitis (4%). Standardized mortality rate for the study population was higher (p = 0.18) when compared to the general population.

CONCLUSION

Our results regarding remission rates and complications are in comparison with previous studies. Surgery of pituitary lesion can be considered a safe and efficient surgery. We noted lower rates of CSF leakage in the later part of the study period and believe that this, in part, was an effect by the introduction of a multidisciplinary surgical skull base team and increased surgical experience.

Deconstructing Ecosystem Service Conflicts through the Prisms of Political Ecology and Game Theory in a North-Western Mediterranean River Basin

Power relationships, access and control, (in)equity, and (in)justice are key modulators of conflicts arising from ecosystem services between multiple stakeholders. A greater knowledge of stakeholder value systems and behaviors is crucial for understanding socioecological dynamics. We propose an analytical framework that combines political ecology and game theory to analyze water ecosystem services. This integrated framework was used to reinterpret concepts such as common goods, (a)symmetric flows, and (un)fair trade-offs in the context of ecosystem services. The purpose was to gain a better understanding of behaviors and (a)symmetries in power relationships between multiple stakeholders. We studied the case of a north-western Mediterranean river basin using data obtained from stakeholder interviews and newspaper articles. Our findings uncovered different types of stakeholder relationships, ranging from mutual support and cooperation to conflict. The proposed analytical framework shows how social mechanisms can affect ecosystem services flows, potentially facilitating or hindering the development of more equitable management models for natural resources.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10745-022-00325-5.