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Geng Y, Dong Q, Cong Z, Zhu J, Li Z, Du C, Yuan F, Zeng X, Ali A, Yang J, Tang C, Ma C. Endocrine Outcomes and Associated Predictive Factors for Somatotrophin Pituitary Adenoma after Endoscopic Endonasal Transsphenoidal Surgery: 10 Years of Experience in a Single Institute. J Neurol Surg B Skull Base 2024; 85:389-396. [PMID: 38966302 PMCID: PMC11221908 DOI: 10.1055/a-2081-1427] [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: 02/08/2023] [Accepted: 04/22/2023] [Indexed: 07/06/2024] Open
Abstract
Objective Biochemical remission rates of endoscopic endonasal transsphenoidal surgery (EETS) and its associated predictive factors were evaluated in patients with somatotrophin pituitary adenomas. Methods The patients who underwent EETS in Jinling Hospital were identified between 2011 and 2020. The surgeons' experience, preoperative insulin-like growth factor 1 (IGF-1), basal growth hormone (GH) levels, nadir GH levels, and the tumor characteristics were analyzed for their relationships with endocrine outcomes. Total 98 patients were included for single factor analysis and regression analysis. They were divided into three groups according to the admission chronologic order. Results The overall remission rate of the patients was 57% (56/98) for all the patients over 10 years. In the single factor analysis, we found that the tumor size, cavernous invasion, and sellar invasion were valuable to predict the endocrine outcome after surgery. As for the suprasellar invasion, no significant difference was found between the noninvasive group and the invasive group. The preoperative IGF-1 level ( p = 0.166), basal GH level ( p = 0.001), and nadir GH level ( p = 0.004) were also different between the remission group and the nonremission group in the single factor analysis. The logistic regression analysis indicated that the preoperative nadir GH (odds ratio = 0.930, 95% confidence interval = 0.891-0.972, p = 0.001) was a significant predictor for the endocrine outcomes after surgery. Conclusion The surgeons' experience is an important factor that can affect the patients' endocrine outcomes after surgery. The macroadenomas with lateral invasion are more difficult to cure. Patients with higher preoperative nadir GH levels are less likely to achieve remission.
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Affiliation(s)
- Yuanming Geng
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Qian Dong
- School of Nursing, Bengbu Medical College, Anhui, People's of Republic of China
- Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
| | - Zixiang Cong
- Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
| | - Junhao Zhu
- Department of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Zhenxing Li
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
- Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
| | - Chaonan Du
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Feng Yuan
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xinrui Zeng
- Department of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
| | - Alleyar Ali
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Jin Yang
- Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
| | - Chao Tang
- Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
| | - Chiyuan Ma
- Department of Neurosurgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China
- Department of Neurosurgery, Jinling Hospital, Nanjing, People's Republic of China
- Department of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China
- School of Medicine, Southeast University, Nanjing, People's Republic of China
- Department of Neurosurgery, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing, People's Republic of China
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Grandgeorge N, Barchetti G, Grunenwald S, Bonneville F, Caron P. MRI follow-up of patients with acromegaly being treated with first-generation somatostatin receptor ligands after surgery. Clin Endocrinol (Oxf) 2022; 97:686-688. [PMID: 34160834 DOI: 10.1111/cen.14539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Naia Grandgeorge
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, Toulouse, France
| | | | - Solange Grunenwald
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, Toulouse, France
| | | | - Philippe Caron
- Department of Endocrinology and Metabolic Diseases, CHU Larrey, Toulouse, France
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Slot EM, Sabaoglu R, Voormolen EH, Hoving EW, van Doormaal TP. Cerebrospinal Fluid Leak after Transsphenoidal Surgery: A Systematic Review and Meta-analysis. J Neurol Surg B Skull Base 2021; 83:e501-e513. [DOI: 10.1055/s-0041-1733918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022] Open
Abstract
Abstract
Background Cerebrospinal fluid (CSF) leak is widely recognized as a challenging and commonly occurring postoperative complication of transsphenoidal surgery (TSS).The primary objective of this study is to benchmark the current prevalence of CSF leak after TSS in the adult population.
Methods The authors followed the PRISMA guidelines. The PubMed, Embase, and Cochrane Library databases were searched for articles reporting CSF leak after TSS in the adult population. Meta-analysis was performed using the Untransformed Proportion metric in OpenMetaAnalyst. For two between-group comparisons a generalized linear mixed model was applied.
Results We identified 2,408 articles through the database search, of which 70, published since 2015, were included in this systematic review. These studies yielded 24,979 patients who underwent a total of 25,034 transsphenoidal surgeries. The overall prevalence of postoperative CSF leak was 3.4% (95% confidence interval or CI 2.8–4.0%). The prevalence of CSF leak found in patients undergoing pituitary adenoma resection was 3.2% (95% CI 2.5–4.2%), whereas patients who underwent TSS for another indication had a CSF leak prevalence rate of 7.1% (95% CI 3.0–15.7%) (odds ratio [OR] 2.3, 95% CI 0.9–5.7). Patients with cavernous sinus invasion (OR 3.0, 95% CI 1.1–8.7) and intraoperative CSF leak (OR 5.9, 95% CI 3.8–9.0) have increased risk of postoperative CSF leak. Previous TSS and microscopic surgery are not significantly associated with postoperative CSF leak.
Conclusion The overall recent prevalence of CSF leak after TSS in adults is 3.4%. Intraoperative CSF leak and cavernous sinus invasion appear to be significant risk factors for postoperative CSF leak.
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Affiliation(s)
- Emma M.H. Slot
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Translational Neuroscience, University Medical Center, Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Rengin Sabaoglu
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eduard H.J. Voormolen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eelco W. Hoving
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Neuro-oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Tristan P.C. van Doormaal
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Translational Neuroscience, University Medical Center, Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
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Taweesomboonyat C, Oearsakul T. Prognostic Factors of Acromegalic Patients with Growth Hormone-Secreting Pituitary Adenoma After Transsphenoidal Surgery. World Neurosurg 2020; 146:e1360-e1366. [PMID: 33309643 DOI: 10.1016/j.wneu.2020.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Acromegaly is a rare, chronic disorder that mostly results from growth hormone (GH)-secreting pituitary adenoma. Transsphenoidal surgery is the first-line treatment of this adenoma. This study aimed to identify factors associated with remission outcome in patients with GH-secreting pituitary adenomas following transsphenoidal surgery. METHODS Patients with GH-secreting pituitary adenomas who underwent transsphenoidal surgery for tumor removal at Songklanagarind Hospital between January 2003 and December 2019 were retrospectively reviewed. The primary outcome was the remission of disease at the last follow-up using 2000 and 2010 consensus criteria. Using logistic regression analysis, various factors were analyzed for association with disease remission outcome. RESULTS This study included 51 patients. The remission rate of GH-secreting pituitary microadenomas and macroadenomas following transsphenoidal surgery were 100% and 43.75%, respectively. Multivariate analysis showed that preoperative insulin-like growth factor 1 index ≥2.5 and Knosp classification grade 3-4 were significantly associated with nonremission outcome (P < 0.001 and P = 0.012, respectively). Patients with both of these factors had poor outcomes and never achieved remission after treatment, while patients with neither of these factors had high remission rates (87.5%) following surgery. Four of 6 (66.7%) patients who underwent repeat surgery gained remission. CONCLUSIONS Preoperative insulin-like growth factor 1 index ≥2.5 and Knosp classification grade 3-4 were important prognostic factors that determined remission outcome after treatment. Patients who have both of these poor prognostic factors should be aggressively treated with surgery, medication, and probably radiation to optimally control the disease.
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Affiliation(s)
- Chin Taweesomboonyat
- Division of Neurosurgery, Department of Surgery, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
| | - Thakul Oearsakul
- Division of Neurosurgery, Department of Surgery, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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