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Faropoulos K, Gioti I, Georgakopoulou VE, Spandidos DA, Papalexis P, Lempesis IG, Trakas N, Trakas I, Anagiotos A, Fotakopoulos G. When age is not an obstacle: A case series of endoscopic transsphenoidal resection of pituitary macroadenomas in older patients. Biomed Rep 2023; 19:86. [PMID: 37881600 PMCID: PMC10594072 DOI: 10.3892/br.2023.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/21/2023] [Indexed: 10/27/2023] Open
Abstract
Due to the increase in life expectancy, the number of elderly patients suffering from a pituitary macroadenoma is expected to increase in the future. The endoscopic endonasal transsphenoidal (EET) approach tends to be the first choice for the treatment of pituitary macroadenomas in the general population. Notwithstanding, in the geriatric population, the goals of management for this condition remain unclear. The present study retrospectively evaluated and describes the cases of 6 patients >70 years of age with a pituitary macroadenoma who were treated by a skull base team, composed of one ENT surgeon and one neurosurgeon. All the patients experienced a notable improvement in their neurological deficit, while their hormonal status also improved or at least did not deteriorate after the surgery. The EET approach appears to be a safe and effective approach for the treatment of pituitary macroadenomas in the geriatric population.
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Affiliation(s)
| | - Ifigeneia Gioti
- Department of Radiotherapy, University Hospital of Patras, 26504 Patras, Greece
| | | | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Petros Papalexis
- Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Ioannis G. Lempesis
- Department of Pathophysiology, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Ilias Trakas
- Department of Pathophysiology, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Andreas Anagiotos
- Department of Otolaryngology, Nicosia General Hospital, 2029 Nicosia, Cyprus
| | - George Fotakopoulos
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
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Rosinha P, Fonseca L, Amaral C, Ribeiro I, Cardoso MH. Pituitary adenomas in the elderly: Retrospective comparative analysis of clinical/tumor features and surgical data by age group. Medicine (Baltimore) 2022; 101:e30825. [PMID: 36181020 PMCID: PMC9524919 DOI: 10.1097/md.0000000000030825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The increase in life expectancy along with technological advances has translated into a higher number of pituitary adenomas (PA) diagnosed from the age of 65. In the elderly, symptoms related to comorbidities might overlap with endocrine dysfunction, in addition to increasing anesthetic and surgical risks. This study aimed to compare baseline clinical and tumor features between patients with PA from different age groups: younger adults (YA), 18 to 64 years, and older adults (OA), ≥65 years. As secondary outcomes, we also intended to assess: clinical characteristics and tumor features in patients undergoing surgical intervention and surgical data and complications in patients undergoing transphenoidal surgery (TSS). This retrospective cohort study included patients diagnosed with PA in adulthood divided into YA and OA groups. The secondary outcomes were evaluated in the subgroups: patients who underwent pituitary surgery and patients specifically submitted to TSS, who had completed postoperative follow-up ≥ 6 months until July/2020. A total of 401 patients were included, 327 (81.5%) in the YA and 74 (18.5%) in the OA group. Hormone-secreting effects were more common in the YA group (P < .001) and mass effects in the OA group (P = .070). The prevalence of hypertension and diabetes was higher in the OA group (P = .002, P = .011). A larger proportion of nonfunctioning (NF) PA and prolactinomas was found in OA (P < .001) and YA (P = .012), respectively. Macroadenomas were more common in the OA group (P < .001). No differences were found in terms of invasiveness. In the secondary outcome analysis, there was a higher prevalence of NF-PA in those who underwent pituitary surgery. The rate of TSS-related complications was similar between the groups for major, minor and endocrine/electrolyte complications. OA-PA clinically differ from the younger: tend to present more frequently with chronic comorbidities and less frequently with hormone-secreting effects, are more often NF and larger in size without a significant increase in invasiveness. The TSS results were reassuring, proving to be equally safe for the elderly.
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Affiliation(s)
- Patrícia Rosinha
- Endocrinology Department, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
- *Correspondence: Patrícia Rosinha, Endocrinology Department, Centro Hospitalar Baixo Vouga, Avenida Artur Ravara, 3810-501 Aveiro, Portugal (e-mail: )
| | - Liliana Fonseca
- Endocrinology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Cláudia Amaral
- Endocrinology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Isabel Ribeiro
- Neurosurgery Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Maria Helena Cardoso
- Endocrinology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
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Chalif EJ, Morshed RA, Young JS, Haddad AF, Jain S, Aghi MK. Pituitary adenoma in the elderly: surgical outcomes and treatment trends in the United States. J Neurosurg 2022; 137:1687-1698. [PMID: 35535847 DOI: 10.3171/2022.3.jns212940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Decision-making in how to manage pituitary adenomas (PAs) in the elderly (age ≥ 65 years) can be challenging given the benign nature of these tumors and concerns about surgical morbidity in these patients. In this study involving a large multicenter national registry, the authors examined treatment trends and surgical outcomes in elderly compared to nonelderly patients. METHODS The National Cancer Data Base (NCDB) was queried for adults aged ≥ 18 years with PA diagnosed by MRI (in observed cases) or pathology (in surgical cases) from 2004 to 2016. Univariate and multivariate logistic regressions were used to evaluate the prognostic impact of age and other covariates on 30- and 90-day postsurgical mortality (30M/90M), prolonged (≥ 5 days) length of inpatient hospital stay (LOS), and extent of resection. RESULTS A total of 96,399 cases met the study inclusion criteria, 27% of which were microadenomas and 73% of which were macroadenomas. Among these cases were 25,464 elderly patients with PA. Fifty-three percent of these elderly patients were treated with surgery, 1.9% underwent upfront radiotherapy, and 44.9% were observed without treatment. Factors associated with surgical treatment compared to observation included younger age, higher income, private insurance, higher Charlson-Deyo comorbidity (CD) score, larger tumor size, and receiving treatment at an academic hospital (each p ≤ 0.01). Elderly patients undergoing surgery had increased rates of 30M (1.4% vs 0.6%), 90M (2.8% vs 0.9%), prolonged LOS (26.1% vs 23.0%), and subtotal resection (27.2% vs 24.5%; each p ≤ 0.01) compared to those in nonelderly PA patients. On multivariate analysis, age, tumor size, and CD score were independently associated with worse postsurgical mortality. High-volume facilities (HVFs) had significantly better outcomes than low-volume facilities: 30M (0.9% vs 1.8%, p < 0.001), 90M (2.0% vs 3.5%, p < 0.001), and prolonged LOS (21.8% vs 30.3%, p < 0.001). A systematic literature review composed of 22 studies demonstrated an elderly PA patient mortality rate of 0.7%, which is dramatically lower than real-world NCDB outcomes and speaks to substantial selection bias in the previously published literature. CONCLUSIONS The study findings confirm that elderly patients with PA are at higher risk for postoperative mortality than younger patients. Surgical risk in this age group may have been previously underreported in the literature. Resection at HVFs better reflects these historical rates, which has important implications in elderly patients for whom surgery is being considered.
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Villar-Taibo R, Díaz-Ortega C, Sifontes-Dubon M, Fernández-Pombo A, Serramito-García R, Martínez-Capoccioni G, Bernabeu I. Pituitary surgery in elderly patients: a safe and effective procedure. Endocrine 2021; 72:814-822. [PMID: 33665774 DOI: 10.1007/s12020-021-02665-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 02/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The incidence of pituitary adenoma (PA) increases with age. Transsphenoidal surgery (TSS) in elderly patients is often considered to have greater risk compared to the younger population. The aim of this study is to compare surgical results, evolution and postoperative complications between elderly and young patients undergoing TSS. METHODS Retrospective review of patients undergoing TSS between 2011 and 2018 in our institution. Patients were divided into two cohorts: elderly (≥65 years) and non-elderly (<65 years). Characteristics and outcomes of both groups were compared at diagnosis, before surgery and for an average of 5.9 years of postoperative follow-up. RESULTS One hundred and twenty-five patients were included, 53 patients were ≥65 years (42%). The elderly patients were more likely to have non-functioning PA (NFPA) (90.5% vs. 45.8%, p: <0.01), a higher proportion of macroadenomas (92.4% vs. 77.8%, p = 0.029) and greater extrasellar extension (88.7% vs. 68.1%, p = 0.007). The elderly group also had more compressive symptoms (54.7% vs. 34.7%, p = 0.035) and hypopituitarism (66% vs. 47.2%, p = 0.029). Overall, surgical and endocrinological outcomes between the two groups were similar. Inpatient mortality in the elderly group was 1.8%. Regarding long-term outcomes, elderly patients had more postoperative hypopituitarism (67.9% vs. 45.8%, p = 0.03) with no differences in permanent diabetes insipidus, less residual tumours (24.5% vs. 40.3%, p = 0.019) and a higher rate of remission after surgery (71.7% vs. 52.8%, p = 0.034). When only NFPA cases were compared, the only significant difference was a higher frequency of macroadenomas in the elderly group. CONCLUSIONS Our results support the safety and efficacy of TSS in elderly patients with PA. Age should not be considered an exclusion criterion for TSS given that successful results can be achieved if an experienced pituitary team is available.
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Affiliation(s)
- R Villar-Taibo
- Endocrinology Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain.
- Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela (A Coruña), Spain.
| | - C Díaz-Ortega
- Endocrinology Department, University Hospital of A Coruña, A Coruña (A Coruña), Spain
| | - M Sifontes-Dubon
- Endocrinology Department, Mateu Orfila General Hospital, Menorca (Balearic Islands), Spain
| | - A Fernández-Pombo
- Endocrinology Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - R Serramito-García
- Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela (A Coruña), Spain
- Neurosurgery Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - G Martínez-Capoccioni
- Otolaryngology Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
| | - I Bernabeu
- Endocrinology Department, University Hospital of Santiago de Compostela, Santiago de Compostela (A Coruña), Spain
- Neoplasia and Differentiation of Endocrine Cells Group, Instituto de Investigación Sanitaria-IDIS (Health Research Institute), Santiago de Compostela (A Coruña), Spain
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5
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Biamonte E, Betella N, Milani D, Lasio GB, Ariano S, Radice S, Lavezzi E, Mazziotti G, Lania A. Impact of age on postsurgical outcomes of nonfunctioning pituitary adenomas. Endocrine 2021; 72:915-922. [PMID: 33242176 DOI: 10.1007/s12020-020-02554-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/11/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The management of pituitary adenomas in the elderly has become a relevant clinical issue, in relationship with improved life expectancy and spreading use of imaging techniques. In this single-center and retrospective study, we investigated the impact of age on peri- and postsurgical outcomes in patients undergoing transnasal sphenoidal (TNS) surgery for pituitary adenomas. METHODS One-hundred-sixty-nine patients (62% males) undergoing endoscopic transphenoidal (TNS) surgery for nonfunctioning pituitary adenomas (NFPAs) were enrolled. Patients were subdivided into three groups according to age tertiles: ≤56 (group 1), 57-69 (group 2), and ≥70 (group 3) years. Postsurgical and endocrinological outcomes were evaluated and compared among the three age groups. RESULTS 37/169 patients (21.9%) developed at least one perisurgical complication, without significant association with the patients' age (P = 0.838), Charlson co-morbidity score (P = 0.326), and American Society of Anesthesiologist score (P = 0.616). In the multivariate regression analysis, the adenoma size resulted the only determinant of perisurgical complication (odds ratio [OR] 1.07, 95% confidence interval [C.I.] 1.00-1.13; P = 0.044). The development and the recovery of at least one pituitary hormone deficiency were observed in 12.2% and 14.2% of patients, respectively. The risk of developing new pituitary hormone deficiencies was correlated with cavernous sinus invasion as evaluated by magnetic resonance imaging (hazard ratio [HR] 4.19, 95% C.I. 1.39-12.66; P = 0.010), whereas the probability to normalize at least one pituitary hormone deficiency was significantly correlated with younger age of patients (HR 0.27, 95% CI 0.12-0.61; P = 0.002). CONCLUSIONS The results of this study reinforce the concept that endoscopic TNS surgery is a safe therapeutic option in the elderly patients with NFPA, even in presence of comorbidities and high anesthetic risk.
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Affiliation(s)
- E Biamonte
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - N Betella
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy
| | - D Milani
- Neurosurgery Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy
| | - G B Lasio
- Neurosurgery Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy
| | - S Ariano
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - S Radice
- Neurosurgery Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy
| | - E Lavezzi
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy
| | - G Mazziotti
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy.
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
| | - A Lania
- Endocrinology, Diabetology and Andrology Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
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Ceccato F, Barbot M, Lizzul L, Cuccarollo A, Selmin E, Merante Boschin I, Daniele A, Saller A, Occhi G, Regazzo D, Scaroni C. Clinical presentation and management of acromegaly in elderly patients. Hormones (Athens) 2021; 20:143-150. [PMID: 32840821 PMCID: PMC7889670 DOI: 10.1007/s42000-020-00235-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/30/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIM Acromegaly is a rare disease with a peak of incidence in early adulthood. However, enhanced awareness of this disease, combined with wide availability of magnetic resonance imaging (MRI), has increased the diagnosis of forms with mild presentation, especially in elderly patients. Moreover, due to increased life expectancy and proactive individualized treatment, patients with early-onset acromegaly are today aging. The aim of our study was to describe our cohort of elderly patients with acromegaly. MATERIALS AND METHODS This is a cross-sectional retrospective study of 96 outpatients. Clinical, endocrine, treatment, and follow-up data were collected using the electronic database of the University Hospital of Padova, Italy. RESULTS We diagnosed acromegaly in 13 patients, aged ≥65 years, presenting with relatively small adenomas and low IGF-1 secretion. Among them, 11 patients were initially treated with medical therapy and half normalized hormonal levels after 6 months without undergoing neurosurgery (TNS). Remission was achieved after TNS in three out of four patients (primary TNS in two); ten patients presented controlled acromegaly at the last visit. Acromegaly-related comorbidities (colon polyps, thyroid cancer, adrenal incidentaloma, hypertension, and bone disease) were more prevalent in patients who had an early diagnosis (31 patients, characterized by a longer follow-up of 24 years) than in those diagnosed aged ≥65 years (5 years of follow-up). CONCLUSIONS Elderly acromegalic patients are not uncommon. Primary medical therapy is a reasonable option and is effectively used, while the rate of surgical success is not reduced. A careful cost-benefit balance is suggested. Disease-specific comorbidities are more prevalent in acromegalic patients with a longer follow-up rather than in those diagnosed aged ≥65 years.
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Affiliation(s)
- Filippo Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University Hospital of Padova, Via Ospedale Civile, 105-35128, Padova, Italy.
- Department of Neurosciences DNS, University of Padova, Padova, Italy.
| | - Mattia Barbot
- Endocrinology Unit, Department of Medicine DIMED, University Hospital of Padova, Via Ospedale Civile, 105-35128, Padova, Italy
| | - Laura Lizzul
- Endocrinology Unit, Department of Medicine DIMED, University Hospital of Padova, Via Ospedale Civile, 105-35128, Padova, Italy
| | - Angela Cuccarollo
- Endocrinology Unit, Department of Medicine DIMED, University Hospital of Padova, Via Ospedale Civile, 105-35128, Padova, Italy
| | - Elisa Selmin
- Endocrinology Unit, Department of Medicine DIMED, University Hospital of Padova, Via Ospedale Civile, 105-35128, Padova, Italy
| | - Isabella Merante Boschin
- Endocrinology Unit, Department of Medicine DIMED, University Hospital of Padova, Via Ospedale Civile, 105-35128, Padova, Italy
- Department of Surgical, Oncological and Gastroenterological Sciences DiSCOG, University of Padova, Padova, Italy
| | - Andrea Daniele
- Endocrinology Unit, Department of Medicine DIMED, University Hospital of Padova, Via Ospedale Civile, 105-35128, Padova, Italy
| | - Alois Saller
- Internal Medicine, Department of Medicine DIMED, University Hospital of Padova, Padova, Italy
| | - Gianluca Occhi
- Department of Biology, University of Padova, Padova, Italy
| | - Daniela Regazzo
- Endocrinology Unit, Department of Medicine DIMED, University Hospital of Padova, Via Ospedale Civile, 105-35128, Padova, Italy
| | - Carla Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University Hospital of Padova, Via Ospedale Civile, 105-35128, Padova, Italy
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Memel Z, Chesney K, Pangal DJ, Bonney PA, Carmichael JD, Zada G. Outcomes Following Transsphenoidal Pituitary Surgery in the Elderly: A Retrospective Single-Center Review. Oper Neurosurg (Hagerstown) 2020; 16:302-309. [PMID: 29800459 DOI: 10.1093/ons/opy109] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/11/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Transsphenoidal surgery (TSS) for pituitary adenomas (PAs) is performed on elderly patients with increasing frequency. More research is necessary to assess the risk factors that are associated with TSS in an aging population. OBJECTIVE To perform a retrospective study on postoperative safety outcomes following TSS in the elderly population stratified by decade of life. METHODS A retrospective chart review of the USC Pituitary Database was conducted to identify patients ≥70 yr, who underwent TSS for PAs between 1995 and 2017. Surgical outcomes were analyzed in elderly (≥70 yr) vs nonelderly (<70 yr) patients. Elderly patients were additionally stratified according to age 70 to 79 vs ≥80 yr. RESULTS The cohorts included 115 elderly patients (70-79 yr: 94 patients; ≥80 yr: 21 patients) and 770 nonelderly patients. Elderly patients presented with more vision loss (62% vs 38%, P < .0001), dizziness (17% vs 6%, P = .0001) and altered mental status (7.3% vs 3%, P = .0451). Overall rates of surgical, medical, and endocrine complications were similar; however, elderly patients had significantly higher rates of postoperative hyponatremia (9.3% vs 4.7%, P = .0401) and lower rates of transient diabetes insipidus (0.9% vs 7.9%, P = .0038). Patients ≥ 80 yr had significantly more surgical complications (26.3%) compared to the 70 to 79 group (7.87%; P = .021) and <70 group (12.5%; P = .04). CONCLUSION Patients >70 yr are appropriate surgical candidates for TSS given the similar safety outcomes as younger patients. Given the higher propensity for surgical complications; however, a higher level of operative selectivity should be maintained in octogenarian patients.
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Affiliation(s)
- Zoe Memel
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Kelsi Chesney
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Dhiraj J Pangal
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Phillip A Bonney
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - John D Carmichael
- Division of Endocrinology, Department of Medicine, Keck School of Medicine of USC, Los Angeles, California
- USC Pituitary Center, USC Keck School of Medicine, Los Angeles, California
| | - Gabriel Zada
- Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, California
- USC Pituitary Center, USC Keck School of Medicine, Los Angeles, California
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Abstract
Aggressive pituitary tumors (APTs) represent rare pituitary adenomas (PAs) with local invasion of surrounding tissues, increased risk for multiple recurrence, rapid tumor growth, or resistance to standard therapies. The most common APTs in children and adolescents are giant prolactinomas and somatotropinomas. Few cases of Crooke's cell adenomas, silent corticotroph adenomas and pituitary carcinomas have also been reported in the literature. Pediatric patients with APTs have higher risk of harboring germline genetic defects, most commonly in the MEN1 and AIP genes. Since certain genetic defects confer a more aggressive behavior to PAs, genetic testing should be considered in tumors with young onset and positive family history. The management of pediatric APTs involves usually a combination of standard therapies (surgical, medical, radiation). Newer agents, such as temozolomide, have been used in few cases of pediatric pituitary tumors with promising results. In the elderly, PAs are more commonly non-functioning. Their management often poses dilemmas given the coexistence of age-related comorbidities. However, standard surgical treatment and temozolomide seem to be safe and well tolerated in elderly patients.
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Affiliation(s)
- Christina Tatsi
- Section on Genetics and Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, 10 Center Drive, Building 10, NIH-Clinical Research Center, Room 1-3330, MSC1103, Bethesda, MD, 20892, USA
| | - Constantine A Stratakis
- Section on Genetics and Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health, 10 Center Drive, Building 10, NIH-Clinical Research Center, Room 1-3330, MSC1103, Bethesda, MD, 20892, USA.
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9
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Tardivo V, Penner F, Garbossa D, Di Perna G, Pacca P, Salvati L, Altieri R, Grottoli S, Zenga F. Surgical management of pituitary adenomas: does age matter? Pituitary 2020; 23:92-102. [PMID: 31797173 DOI: 10.1007/s11102-019-01014-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Along with increased life expectancy and improvements in the diagnostic tools and techniques, the number of elderly patients with symptomatic pituitary tumors being evaluated for surgery is increasing. To date, contrasting results of the safety and effectiveness of transsphenoidal surgery in patients over 65 years old were published in the medical literature. An investigation concerning the extension of resection, post operative complications and, recovery rate from endocrinological and visual symptoms in elderly patients who underwent transsphenoidal surgery for pituitary adenoma was conducted. METHODS A retrospective review, which included a series of 81 patients 65 years old or older who underwent endoscopic endonasal surgery for pituitary adenomas was analyzed. Pre operative and post operative data were collected and patients were then compared among four age groups: 65-69 years old, 70-74 years old, 75-79 years old and 80 years and over. The results were then compared with the findings from the medical literature review. RESULTS The statistical analysis failed to highlight any difference in terms of clinical presentation or complications among the four age groups, however there seems to be a slightly higher risk of post operative hypopituitarism in patients over 74 years old. CONCLUSION The results of the study seem to confirm that transsphenoidal surgery for PA is safe and effective among patients that are 65 and over. Moreover, a partial resection is preferred over a gross total one in order to reduce the surgical risk.
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Affiliation(s)
- Valentina Tardivo
- Department of Surgical Sciences, University of Torino, 10126, Turin, Italy.
- Neurosurgery Unit, Ente Ospedaliero Galliera, Genoa, Italy.
| | - Federica Penner
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Torino, 10126, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Torino, 10126, Turin, Italy
| | - Giuseppe Di Perna
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Torino, 10126, Turin, Italy
| | - Paolo Pacca
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Torino, 10126, Turin, Italy
| | - Luca Salvati
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Torino, 10126, Turin, Italy
| | - Roberto Altieri
- Department of Anatomy, Biology and Genetics, Legal Medicine, Neuroscience, Diagnostic Pathology, Hygiene and Public Health (DANA) "Gian Filippo Ingrassia", Univeristy of Catania, Catania, Italy
| | - Silvia Grottoli
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Science, University of Torino, Turin, Italy
| | - Francesco Zenga
- Department of Neuroscience "Rita Levi Montalcini", Neurosurgery Unit, University of Torino, 10126, Turin, Italy
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Spina A, Losa M, Mortini P. Pituitary adenomas in elderly patients: clinical and surgical outcome analysis in a large series. Endocrine 2019; 65:637-645. [PMID: 31209675 DOI: 10.1007/s12020-019-01959-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/12/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The increased life expectancy in the general population is causing rapid growth of the number of elderly patients. Pituitary adenomas (PAs) are one of those tumors whose incidence increases with age. Pituitary surgery in elderly has usually been considered riskier than in the younger population. The aim of this study was to evaluate the surgical outcome of a large series of patients who underwent transsphenoidal surgery for PAs. METHODS We retrospectively reviewed a series of patients who underwent transsphenoidal surgery for PAs in our institution. Inclusion criteria were: 65 years of age or more, and no previous pituitary surgery. Surgical outcomes of patients aged <70 years (group 1) was compared to those aged 70 years or more (group 2) at the time of surgery. RESULTS A total of 336 patients met the inclusion criteria. Clinically, 230 (68.5%) patients had a non-functioning PAs. Among the remaining 106 patients with a hormone-secreting PA, 57 (53.8%) had acromegaly, 39 (36.8%) Cushing's disease, 5 patients (4.7%) had a prolactinoma, and 5 a thyrotropin-secreting PA (4.7%). Mortality rate was 1.5%. Groups 1 and 2 showed no significantly different surgery-related complication, visual recovery, radical surgery, and remission rates. CONCLUSIONS Surgical management of PAs in the elderly has been considered riskier than in the younger population. Our results demonstrated that transsphenoidal surgery is a safe and effective treatment for PAs. No statistically significant differences in terms of outcome were found in two group ages, showing that, when clinically indicated, transsphenoidal surgery can be performed even in very old subjects.
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Affiliation(s)
- Alfio Spina
- Pituitary Unit of the Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
| | - Marco Losa
- Pituitary Unit of the Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Pietro Mortini
- Pituitary Unit of the Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
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11
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Azab MA, O'Hagan M, Abou-Al-Shaar H, Karsy M, Guan J, Couldwell WT. Safety and Outcome of Transsphenoidal Pituitary Adenoma Resection in Elderly Patients. World Neurosurg 2019; 122:e1252-e1258. [DOI: 10.1016/j.wneu.2018.11.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 11/30/2022]
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12
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Kinoshita Y, Kurisu K, Arita K. Nonfunctioning pituitary adenomas in elderly patients. J Clin Neurosci 2018; 53:127-131. [PMID: 29739724 DOI: 10.1016/j.jocn.2018.04.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/22/2018] [Indexed: 10/17/2022]
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13
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Zhao Y, Lian W, Xing B, Feng M, Liu X, Wang R, Wu H. The clinical characteristics and microsurgical therapy of pituitary adenomas in elderly patients: A retrospective study of 130 cases. J Clin Neurosci 2017; 46:13-16. [DOI: 10.1016/j.jocn.2017.08.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
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14
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Jones SH, Iannone AF, Patel KS, Anchouche K, Raza SM, Anand VK, Schwartz TH. The Impact of Age on Long-Term Quality of Life After Endonasal Endoscopic Resection of Skull Base Meningiomas. Neurosurgery 2017; 79:736-745. [PMID: 27465844 DOI: 10.1227/neu.0000000000001360] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Midline ventral skull base meningiomas may be amenable to an endonasal endoscopic approach, which has theoretical advantages and may help preserve quality of life (QOL) when compared with transcranial approaches. OBJECTIVE To investigate the effect of age on QOL following endonasal endoscopic surgery, given the documented impact of age on QOL outcomes following transcranial resection of midline ventral skull base meningiomas. METHODS We reviewed a prospectively acquired database of endonasal endoscopic surgery for meningiomas. Inclusion criteria included patients who had completed long-term postoperative (≥6 months follow-up) QOL questionnaires (Anterior Skull Base Questionnaire [ASBQ] and Sino-Nasal Outcome Test [SNOT-22]). Postoperative QOL scores were also compared with preoperative QOL in a patient subset. RESULTS Long-term QOL data were available in 34 patients. Average postoperative ASBQ and SNOT-22 scores were 3.39 and 23.0, respectively. Better QOL was statistically associated with age <55 (P = .02). In a subset of patients, preoperative and postoperative ASBQ and SNOT-22 scores were compared. Only SNOT-22 scores significantly increased from 15.9 + 20.8 to 25.9 + 19.5 (P = .04). CONCLUSION We report the first study specifically evaluating long-term QOL after endonasal endoscopic resection of skull base meningiomas. QOL was decreased postoperatively in patients aged ≥55. ABBREVIATIONS ASBQ, Anterior Skull Base QuestionnaireGTR, gross total resectionQOL, quality of lifeSNOT-22, 22-item Sino-Nasal Outcome Test.
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Affiliation(s)
- Samuel H Jones
- Departments of *Neurological Surgery,‡Otolaryngology, and§Neuroscience, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York
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Fujimoto K, Yano S, Shinojima N, Hide T, Kuratsu JI. Endoscopic endonasal transsphenoidal surgery for patients aged over 80 years with pituitary adenomas: Surgical and follow-up results. Surg Neurol Int 2017; 8:213. [PMID: 28966819 PMCID: PMC5609439 DOI: 10.4103/sni.sni_189_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/15/2017] [Indexed: 11/30/2022] Open
Abstract
Background: With the rapid aging of the general population, the number of pituitary adenoma (PA) diagnosed in elderly patients is increasing. The aim of this study was to evaluate the efficacy of endoscopic endonasal transsphenoidal surgery (ETSS) for PA in patients aged ≥80 years. Methods: We retrospectively reviewed the medical records of all patients aged ≥80 years who underwent ETSS for PA at our hospital from January 2001 through December 2014. Treatment results were assessed by the extent of surgical removal, symptom improvement, postoperative complications, and Karnofsky performance status (KPS). The results were also compared with the surgical result of PA patients aged <80 years. Results: Twelve patients aged ≥80 years underwent ETSS for PA. Recovery of visual function was observed in 11 patients (91.7%). Postoperative cerebrospinal fluid (CSF) leakage was observed in 3 patients. New hormonal replacement therapy was required in 2 patients. These complications had not affected patient prognosis. During the follow-up periods, deterioration of KPS was observed in 2 patients due to pneumonia or cerebral infarction. In total, 150 PA patients aged <80 years were compared with the patients aged ≥80 years. The percentage of total removal was significantly higher in the younger patient group than that in the older one (54.0% vs 16.6%, respectively; P = 0.016). Visual improvement was observed in 93.2% of the younger patient group, which was almost equal to that in the older one. Conclusion: ETSS is a safe and effective surgical technique in PA patients aged ≥80 years.
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Affiliation(s)
- Kenji Fujimoto
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Shigetoshi Yano
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Naoki Shinojima
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Takuichiro Hide
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University School of Medicine, Kumamoto, Japan
| | - Jun-Ichi Kuratsu
- Department of Neurosurgery, Faculty of Life Sciences, Kumamoto University School of Medicine, Kumamoto, Japan
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Chinezu R, Fomekong F, Lasolle H, Trouillas J, Vasiljevic A, Raverot G, Jouanneau E. Risks and Benefits of Endoscopic Transsphenoidal Surgery for Nonfunctioning Pituitary Adenomas in Patients of the Ninth Decade. World Neurosurg 2017; 106:315-321. [PMID: 28676462 DOI: 10.1016/j.wneu.2017.06.151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The population older than 80 years of age (very elderly) is increasing, and the management of these patients with pituitary surgery is controversial. OBJECTIVE To determine the prevalence of pituitary tumors in elderly patients and to determine the safety of endoscopic transsphenoidal pituitary surgery for nonfunctioning pituitary adenomas in patients aged older than 80 years. METHODS This retrospective study included elderly (65-75 years old) and very elderly consecutive patients operated between 2007 and 2015 for nonfunctioning pituitary adenomas. Tumor characteristics, comorbidities, pre- and postoperative visual and endocrinologic status, and postoperative complications were compared. RESULTS Of the total 623 operated patients, 307 had nonfunctioning pituitary adenomas. Twenty-three percent (n = 143) of all patients were aged older than 65 years, whereas 2.56% (n = 16) were aged older than 80 years. Gonadotroph and nonimmunoreactive tumors occurred in 81% of patients aged older than 65 years. The study groups were Group A, comprising 15 patients aged older than 80 years, and Group B, comprising 49 patients aged 65-75 years. No presurgical statistical differences were noted between the 2 groups. Complete tumor resection was achieved in 53.3% of Group A and 73.5% of Group B. Postsurgical visual status improved significantly in Group A than in Group B (P = 0.0012). No deaths occurred, and no group differences were noted in the postoperative complications. CONCLUSIONS Age exceeding 80 years is not by itself a predictor of worse clinical outcome of endoscopic transsphenoidal pituitary surgery for nonfunctioning adenomas. Emphasis should be placed on visual pathway decompression for the quality of life in very old people.
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Affiliation(s)
- Rares Chinezu
- Universitatea de Medicină Şi Farmacie Tîrgu Mures, Tîrgu Mureş, Romania; Clinica de Neurochirurgie, Spitalul Clinic Judeţean de Urgenţă Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Franklin Fomekong
- Service de Neurochirurgie B, Chirurgie de la base du Crâne et de l'hypophyse, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; Inserm U1052, CNRS UMR5286, « Signaling, metabolism and tumor progression » Centre anti-cancéreux, Lyon, France
| | - Héllène Lasolle
- Fédération d'endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | | | - Alexandre Vasiljevic
- Centre de pathologie et de biologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon I, Lyon, France
| | - Gerald Raverot
- Inserm U1052, CNRS UMR5286, « Signaling, metabolism and tumor progression » Centre anti-cancéreux, Lyon, France; Fédération d'endocrinologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon I, Lyon, France
| | - Emmanuel Jouanneau
- Service de Neurochirurgie B, Chirurgie de la base du Crâne et de l'hypophyse, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France; Inserm U1052, CNRS UMR5286, « Signaling, metabolism and tumor progression » Centre anti-cancéreux, Lyon, France; Université Claude Bernard Lyon I, Lyon, France.
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17
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Wilson PJ, Omay SB, Kacker A, Anand VK, Schwartz TH. Endonasal endoscopic pituitary surgery in the elderly. J Neurosurg 2017; 128:429-436. [PMID: 28387628 DOI: 10.3171/2016.11.jns162286] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pituitary adenomas are benign, slow-growing tumors that cause symptoms either through mass effect or hormone overproduction. The decision to operate on a healthy young person is relatively straightforward. In the elderly population, however, the risks of complications may increase, rendering the decision more complex. Few studies have documented the risks of surgery using the endonasal endoscopic approach in a large number of elderly patients. The purpose of this study was to audit a single center's data regarding outcomes of purely endoscopic endonasal transsphenoidal resection of pituitary adenomas in elderly patients and to compare them to the current literature. METHODS A retrospective review of a prospectively acquired database of all endonasal endoscopic surgeries done by the senior authors was queried for patients aged 60-69 years and for those aged 70 years or older. Demographic and radiographic preoperative data were reviewed. Outcomes with respect to extent of resection and complications were examined and compared with appropriate statistical tests. RESULTS A total of 135 patents were identified (81 aged 60-69 years and 54 aged 70 years or older [70+]). The average tumor diameter was slightly larger for the patients in the 70+ age group (mean [SD] 25.7 ± 9.2 mm) than for patients aged 60-69 years (23.1 ± 9.8 mm, p = 0.056). There was no significant difference in intraoperative blood loss (p > 0.99), length of stay (p = 0.22), or duration of follow-up (p = 0.21) between the 2 groups. There was a 7.4% complication rate in patients aged 60-69 years (3 nasal and 3 medical complications) and an 18.5% complication rate in patients older than 70 years (4 cranial, 3 nasal, 1 visual, and 2 medical complications; p = 0.05 overall and 0.013 for cranial complications). Cranial complications in the 70+ age category included 2 postoperative hematomas, 1 pseudoaneurysm formation, and 1 case of symptomatic subdural hygromas. CONCLUSIONS Endonasal endoscopic surgery in elderly patients is safe, but there is a graded increase in complication rates with increasing age. The decision to operate on an asymptomatic or mildly symptomatic patient in these age groups should take this increasing complication rate into account. The use of a lumbar drain or lumbar punctures should be weighed against the risk of subdural hematoma in patients with preexisting atrophy.
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Affiliation(s)
- Peter J Wilson
- Departments of1Neurosurgery.,2Department of Neurosurgery, Prince of Wales Hospital, Sydney, New South Wales,Australia
| | | | | | | | - Theodore H Schwartz
- Departments of1Neurosurgery.,3Otolaryngology, and.,4Neuroscience, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York; and
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18
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Marenco HA, Zymberg ST, Santos RDP, Ramalho CO. Surgical treatment of non-functioning pituitary macroadenomas by the endoscopic endonasal approach in the elderly. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 73:764-9. [PMID: 26352495 DOI: 10.1590/0004-282x20150112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Over the past three decades, surgical series of elderly patients treated for pituitary adenomas have been published, all of which used the microscopic transsphenoidal or transcranial approach. The objective of this study was to retrospectively analyze the surgical results of our first 25 elderly patients with non-functioning pituitary macroadenoma (NFPM) operated by the endoscopic endonasal approach (EEA). Preoperative visual loss was found in 92.8% of the cases, and 70.8% experienced visual improvement following surgery. Preoperative pituitary dysfunction was found in 69.2% of the cases and postoperative pituitary recovery occurred in 22.2% of them. Mean hospital stay was 6.7 days. The results of this study suggest that surgery remains the first line of treatment for NFPM in the elderly. Because age alone is not a barrier for surgery, patients should be selected for surgical treatment based on their symptoms and clinical condition, as defined by comorbidities.
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Affiliation(s)
| | - Samuel Tau Zymberg
- Departamento de Otorrinolaringologia, Universidade Federal de São Paulo, São Paulo, SP, BR
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Cheng Y, Gao H, Song G, Li Y, Zhao G. Anatomical study of pterygoid canal (PC) and palatovaginal canal (PVC) in endoscopic trans-sphenoidal approach. Surg Radiol Anat 2015; 38:541-9. [PMID: 26691918 DOI: 10.1007/s00276-015-1597-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The primary purpose of our work was to make anatomical measurements of pterygoid canal (PC) and palatovaginal canal (PVC). The secondary goal was to locate the two structures based on the landmarks in the trans-sphenoidal surgery and draw a safe corridor of fenestration in the bottom of sphenoid sinus during surgical procedure to sphenopalatine region. MATERIALS AND METHODS Computed tomographic angiography (CTA) images of PC, PVC and sphenoid sinus in 200 adults were reviewed. Multiplanar reconstruction of the CT images was performed, and the anatomical features of the PC and PVC were studied in the coronal, sagittal, and axial planes. The length, diameter and direction of PC and PVC were measured in the plane through or perpendicular to them. The anterior and posterior opening of PC and PVC were identified by the surgical landmarks such as the middle lowest point of sellar floor, the sagittal midline and the bottom of the sphenoid sinus. RESULT Both PC and PVC can be found and identified easily on CTA image, the shape and size of the PC and PVC were in agreement with those retrieved from previous literatures, the position of them can be located by the anatomical landmarks in sphenoid sinus. CONCLUSION Knowing the anatomical features of PC and PVC and their location based on the anatomical landmarks are helpful to the endoscopic trans-sphenoidal surgery. These data in our study will provide surgeons a better understanding of PC and PVC and their relationship to sphenoid sinus. Notably, it will not help the surgeons to avoid injuring neurovascular structures as well as provided supportive information for the choice of the appropriate endoscopic equipment.
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Affiliation(s)
- Ye Cheng
- Department of Neurosurgery, First Hospital of Jilin University, No. 71, Xinmin Street, Chaoyang District, Changchun, Jilin, China
| | - Haijun Gao
- Department of Neurosurgery, First Hospital of Jilin University, No. 71, Xinmin Street, Chaoyang District, Changchun, Jilin, China
| | - Ge Song
- Department of Thoracic Surgery, Second Hospital of Jilin University, No. 218 Ziqiang Street, Nanguan District, Changchun, Jilin, China
| | - Yunqian Li
- Department of Neurosurgery, First Hospital of Jilin University, No. 71, Xinmin Street, Chaoyang District, Changchun, Jilin, China.
| | - Gang Zhao
- Department of Neurosurgery, First Hospital of Jilin University, No. 71, Xinmin Street, Chaoyang District, Changchun, Jilin, China.
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Cheng Y, Zhang S, Chen Y, Zhao G. Safe Corridor to Access Clivus for Endoscopic Trans-Sphenoidal Surgery: A Radiological and Anatomical Study. PLoS One 2015; 10:e0137962. [PMID: 26368821 PMCID: PMC4569549 DOI: 10.1371/journal.pone.0137962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/24/2015] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Penetration of the clivus is required for surgical access of the brain stem. The endoscopic transclivus approach is a difficult procedure with high risk of injury to important neurovascular structures. We undertook a novel anatomical and radiological investigation to understand the structure of the clivus and neurovascular structures relevant to the extended trans-nasal trans-sphenoid procedure and determine a safe corridor for the penetration of the clivus. METHOD We examined the clivus region in the computed tomographic angiography (CTA) images of 220 adults, magnetic resonance (MR) images of 50 adults, and dry skull specimens of 10 adults. Multiplanar reconstruction (MPR) of the CT images was performed, and the anatomical features of the clivus were studied in the coronal, sagittal, and axial planes. The data from the images were used to determine the anatomical parameters of the clivus and neurovascular structures, such as the internal carotid artery and inferior petrosal sinus. RESULTS The examination of the CTA and MR images of the enrolled subjects revealed that the thickness of the clivus helped determine the depth of the penetration, while the distance from the sagittal midline to the important neurovascular structures determined the width of the penetration. Further, data from the CTA and MR images were consistent with those retrieved from the examination of the cadaveric specimens. CONCLUSION Our findings provided certain pointers that may be useful in guiding the surgery such that inadvertent injury to vital structures is avoided and also provided supportive information for the choice of the appropriate endoscopic equipment.
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Affiliation(s)
- Ye Cheng
- Department of Neurosurgery, First Hospital of Jilin University, Changchun City, Jilin Province, P. R. China
| | - Siwen Zhang
- Department of Endocrine, First Hospital of Jilin University, Changchun City, Jilin Province, P. R. China
| | - Yong Chen
- Department of Neurosurgery, First Hospital of Jilin University, Changchun City, Jilin Province, P. R. China
| | - Gang Zhao
- Department of Neurosurgery, First Hospital of Jilin University, Changchun City, Jilin Province, P. R. China
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21
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Zhan R, Ma Z, Wang D, Li X. Pure Endoscopic Endonasal Transsphenoidal Approach for Nonfunctioning Pituitary Adenomas in the Elderly: Surgical Outcomes and Complications in 158 Patients. World Neurosurg 2015; 84:1572-8. [PMID: 26341428 DOI: 10.1016/j.wneu.2015.08.035] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of the endoscopic endonasal transsphenoidal approach (EETA) for nonfunctioning pituitary adenoma (NFPA) in the elderly population. METHODS We performed a retrospective review of operative cases over a 7-year period, in which 158 elderly patients (age 65 years and older) who underwent a pure EETA to remove a pituitary adenoma were identified and compared with a series of 155 younger patients (age 40-55 years) who underwent the same procedure during the same period. The medical charts of the patients were reviewed to collect demographic information, such as age, sex, clinical symptoms, tumor size, the extent of tumor resection, clinical outcome, and complications. RESULTS In the elderly group, total resection was achieved in 120 patients (75.9%), and 124 patients (78.5%) achieved significant postsurgical visual remission. In the younger group, total resection was achieved in 119 patients (76.8%), with 126 patients (81.2%) achieving significant postsurgical visual remission. Regarding surgical complications in the elderly group, transient diabetes insipidus occurred postoperatively in 28 (17.8%) patients, and permanent diabetes insipidus occurred in 7 (4.4%) patients. Six (6.4%) patients experienced postoperative cerebrospinal fluid leakage, and new developments of anterior hypopituitarism occurred in 15 (9.5%) cases. In the younger group, 21 (13.6%) patients developed transient diabetes insipidus postoperatively, and 5 (3.2%) patients experienced permanent diabetes insipidus. Six (3.9%) patients reported postoperative cerebrospinal fluid leaks, and 13 (8.4%) patients developed a new anterior hypopituitarism. There were no cases of either carotid artery injury or death in either group. During the follow-up (mean, 32 months), 11 (6.9%) patients experienced tumor recurrence in the elderly group compared with 24 (15.5%) patients in the younger group. Of the 15 elderly patients who developed new hypopituitarism, 13 (86.7%) recovered without hormone replacement; accordingly, the rate of hypopituitarism remission was 84.6% in the younger patients. CONCLUSIONS NFPAs in the elderly can be resected via a pure endoscopic technique with low morbidity and mortality.
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Affiliation(s)
- Rucai Zhan
- Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Science Research Institute, Shandong University, Jinan, Shandong, China; Department of Neurosurgery, The Third People's Hospital of Jinan, Jinan, Shandong, China
| | - Zhenshen Ma
- Department of Medical Imaging, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Donghai Wang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Science Research Institute, Shandong University, Jinan, Shandong, China
| | - Xingang Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Science Research Institute, Shandong University, Jinan, Shandong, China.
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Liu J, Li C, Xiao Q, Gan C, Chen X, Sun W, Li X, Xu Y, Chen J, Shu K, Lei T. Comparison of Pituitary Adenomas in Elderly and Younger Adults: Clinical Characteristics, Surgical Outcomes, and Prognosis. J Am Geriatr Soc 2015; 63:1924-30. [PMID: 26313332 DOI: 10.1111/jgs.13590] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Junfeng Liu
- Department of Neurosurgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Chaoxi Li
- Department of Neurosurgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Qungen Xiao
- Department of Neurosurgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Chao Gan
- Department of Neurosurgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Xi Chen
- Department of Neurosurgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Wei Sun
- Department of Neurosurgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Xiaopeng Li
- Department of Neurosurgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Yu Xu
- Department of Neurosurgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Juan Chen
- Department of Neurosurgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Kai Shu
- Department of Neurosurgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Ting Lei
- Department of Neurosurgery; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
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Pivonello R, De Leo M, Cozzolino A, Colao A. The Treatment of Cushing's Disease. Endocr Rev 2015; 36:385-486. [PMID: 26067718 PMCID: PMC4523083 DOI: 10.1210/er.2013-1048] [Citation(s) in RCA: 288] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/13/2015] [Indexed: 12/23/2022]
Abstract
Cushing's disease (CD), or pituitary-dependent Cushing's syndrome, is a severe endocrine disease caused by a corticotroph pituitary tumor and associated with increased morbidity and mortality. The first-line treatment for CD is pituitary surgery, which is followed by disease remission in around 78% and relapse in around 13% of patients during the 10-year period after surgery, so that nearly one third of patients experience in the long-term a failure of surgery and require an additional second-line treatment. Patients with persistent or recurrent CD require additional treatments, including pituitary radiotherapy, adrenal surgery, and/or medical therapy. Pituitary radiotherapy is effective in controlling cortisol excess in a large percentage of patients, but it is associated with a considerable risk of hypopituitarism. Adrenal surgery is followed by a rapid and definitive control of cortisol excess in nearly all patients, but it induces adrenal insufficiency. Medical therapy has recently acquired a more important role compared to the past, due to the recent employment of novel compounds able to control cortisol secretion or action. Currently, medical therapy is used as a presurgical treatment, particularly for severe disease; or as postsurgical treatment, in cases of failure or incomplete surgical tumor resection; or as bridging therapy before, during, and after radiotherapy while waiting for disease control; or, in selected cases, as primary therapy, mainly when surgery is not an option. The adrenal-directed drug ketoconazole is the most commonly used drug, mainly because of its rapid action, whereas the glucocorticoid receptor antagonist, mifepristone, is highly effective in controlling clinical comorbidities, mainly glucose intolerance, thus being a useful treatment for CD when it is associated with diabetes mellitus. Pituitary-directed drugs have the advantage of acting at the site responsible for CD, the pituitary tumor. Among this group of drugs, the dopamine agonist cabergoline and the somatostatin analog pasireotide result in disease remission in a consistent subgroup of patients with CD. Recently, pasireotide has been approved for the treatment of CD when surgery has failed or when surgery is not an option, and mifepristone has been approved for the treatment of Cushing's syndrome when associated with impairment of glucose metabolism in case of the lack of a surgical indication. Recent experience suggests that the combination of different drugs may be able to control cortisol excess in a great majority of patients with CD.
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Affiliation(s)
- Rosario Pivonello
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Universita' Federico II di Napoli, 80131 Naples, Italy
| | - Monica De Leo
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Universita' Federico II di Napoli, 80131 Naples, Italy
| | - Alessia Cozzolino
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Universita' Federico II di Napoli, 80131 Naples, Italy
| | - Annamaria Colao
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione Di Endocrinologia, Universita' Federico II di Napoli, 80131 Naples, Italy
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MALDI mass spectrometry imaging analysis of pituitary adenomas for near-real-time tumor delineation. Proc Natl Acad Sci U S A 2015. [PMID: 26216958 DOI: 10.1073/pnas.1423101112] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
We present a proof of concept study designed to support the clinical development of mass spectrometry imaging (MSI) for the detection of pituitary tumors during surgery. We analyzed by matrix-assisted laser desorption/ionization (MALDI) MSI six nonpathological (NP) human pituitary glands and 45 hormone secreting and nonsecreting (NS) human pituitary adenomas. We show that the distribution of pituitary hormones such as prolactin (PRL), growth hormone (GH), adrenocorticotropic hormone (ACTH), and thyroid stimulating hormone (TSH) in both normal and tumor tissues can be assessed by using this approach. The presence of most of the pituitary hormones was confirmed by using MS/MS and pseudo-MS/MS methods, and subtyping of pituitary adenomas was performed by using principal component analysis (PCA) and support vector machine (SVM). Our proof of concept study demonstrates that MALDI MSI could be used to directly detect excessive hormonal production from functional pituitary adenomas and generally classify pituitary adenomas by using statistical and machine learning analyses. The tissue characterization can be completed in fewer than 30 min and could therefore be applied for the near-real-time detection and delineation of pituitary tumors for intraoperative surgical decision-making.
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Castinetti F, Dufour H, Gaillard S, Jouanneau E, Vasiljevic A, Villa C, Trouillas J. Non-functioning pituitary adenoma: when and how to operate? What pathologic criteria for typing? ANNALES D'ENDOCRINOLOGIE 2015; 76:220-7. [PMID: 26070464 DOI: 10.1016/j.ando.2015.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
After diagnosis of non-functioning pituitary adenoma and impact assessment (pituitary deficiency, visual field disorder), the question of management arises between surgery and surveillance. This part of the Consensus document aims to clarify the principal situations encountered in clinical practice (visual disorder, pituitary deficiency, asymptomatic adenoma, etc.), so as to determine which ones indicate surgery and which ones simple surveillance. Particular contexts are also dealt with (elderly patients, young women hoping for pregnancy, etc). The principal surgical techniques (microscopy, endoscopy, etc.) are also considered. Finally, in case of surgery, the principal pathologic criteria are specified (immunolabeling, proliferation markers, etc.).
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Affiliation(s)
- Frederic Castinetti
- Service d'endocrinologie, hôpital de la Timone, Aix-Marseille université, AP-HM, 13000 Marseille, France.
| | - Henry Dufour
- Service de neurochirurgie, hôpital de la Timone, Aix-Marseille université, AP-HM, 13000 Marseille, France
| | | | - Emmanuel Jouanneau
- Service de neurochirurgie, hospices civils de Lyon, groupement hospitalier Est, 69495 Lyon, France
| | - Alexandre Vasiljevic
- Centre de pathologie Est, hospices civils de Lyon, groupement hospitalier Est, 69495 Lyon, France
| | - Chiara Villa
- Departement d'anatomo-pathologie et cytologie, hôpital Foch, 92151 Suresnes, France; Inserm unité 1016, Institut Cochin, université Paris-Descartes, 75014 Paris, France; Departement d'endocrinologie, université de Liège, CHU de Liège, domaine universitaire du Sart-Tilman, 4000 Liège, Belgium
| | - Jacqueline Trouillas
- Centre de pathologie Est, hospices civils de Lyon, groupement hospitalier Est, 69495 Lyon, France; Departement d'anatomo-pathologie et cytologie, hôpital Foch, 92151 Suresnes, France; Inserm unité 1016, Institut Cochin, université Paris-Descartes, 75014 Paris, France; Departement d'endocrinologie, université de Liège, CHU de Liège, domaine universitaire du Sart-Tilman, 4000 Liège, Belgium; Laboratoire d'histologie et d'embryologie moléculaires, faculté de médecine Lyon-Est, 69495 Lyon, France
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Outcome of Elderly Patients with Meningioma after Image-Guided Stereotactic Radiotherapy: A Study of 100 Cases. BIOMED RESEARCH INTERNATIONAL 2015; 2015:868401. [PMID: 26101778 PMCID: PMC4460196 DOI: 10.1155/2015/868401] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 12/22/2014] [Indexed: 12/20/2022]
Abstract
Introduction. Incidence of meningioma increases with age. Surgery has been the mainstay treatment. Elderly patients, however, are at risk of severe morbidity. Therefore, we conducted this study to analyze long-term outcomes of linac-based fractionated stereotactic radiotherapy (FSRT) for older adults (aged ≥65 years) with meningioma and determine prognostic factors. Materials and Methods. Between October 1998 and March 2009, 100 patients (≥65, median age, 71 years) were treated with FSRT for meningioma. Two patients were lost to follow-up. Eight patients each had grade I and grade II meningiomas, and five patients had grade III meningiomas. The histology was unknown in 77 cases (grade 0). Results. The median follow-up was 37 months, and 3-year, 5-year, and 10-year progression-free survival (PFS) rates were 93.7%, 91.1%, and 82%. Patients with grade 0/I meningioma showed 3- and 5-year PFS rates of 98.4% and 95.6%. Patients with grade II or III meningiomas showed 3-year PFS rates of 36%. 93.8% of patients showed local tumor control. Multivariate analysis did not indicate any significant prognostic factors. Conclusion. FSRT may play an important role as a noninvasive and safe method in the clinical management of older patients with meningioma.
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Stereotactic radiotherapy of benign meningioma in the elderly: Clinical outcome and toxicity in 121 patients. Radiother Oncol 2014; 111:457-62. [DOI: 10.1016/j.radonc.2014.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 04/11/2014] [Accepted: 04/13/2014] [Indexed: 11/20/2022]
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Wilson P, Williams J, Smee R. Cushing’s disease: A single centre’s experience using the linear accelerator (LINAC) for stereotactic radiosurgery and fractionated stereotactic radiotherapy. J Clin Neurosci 2014; 21:100-6. [DOI: 10.1016/j.jocn.2013.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/17/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
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Cheng Y, Liu M, Zhang S, Tian Y, Song D, Li Y, Luo Q. Optic canal (OC) and internal carotid artery (ICA) in sellar region. Surg Radiol Anat 2013; 35:797-801. [PMID: 24005376 DOI: 10.1007/s00276-013-1193-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 08/17/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE OC and ICA are important structures in sellar region, the injury of ICA and optic nerve can be the severe complications in the operations related to sellar region such as the transsphenoidal surgery and extended transsphenoidal surgery. So knowing their position and their relationship to stable structures in sellar region is of great importance. The aim of our study is to provide specific and comprehensive data about the location of OC and ICA in sellar region in order to guide the surgeons through difficulties in surgeries related to sellar region. METHODS Computer topographic angiography (CTA) images of 200 individuals were reviewed, the measurement was performed on coronal, sagittal and axis planes after multiplanar reformation (MPR). We located OC by the tubercular recess (TR) and the top edge of sphenoid sinus, we located ICA by the midpoint of sellar floor (SF) and the top edge of sphenoid sinus. RESULT OC can be located by TR and the distance between OC and sagittal midline; ICA can be located by midpoint of SF and distance between ICA and sagittal midline; ICA has stationary relationship to ACP. CONCLUSION Knowing the anatomical position of OC and ICA and the positional relationship between them and the sellar region is of great importance in the surgeries related to the sellar region such as the trans-sphenoidal approach to pituitary and extended transsphenoidal surgery to non-pituitary adenoma lesions.
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Affiliation(s)
- Ye Cheng
- Department of Neurosurgery, First Hospital of Jilin University, No.71, Xinmin Street, Chaoyang District, Changchun, Jilin, China
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