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Guinto G, Guinto-Nishimura GY, Uribe-Pacheco R, Sangrador-Deitos MV, Villanueva-Castro E, García-Iturbide R, Gallardo D, Guinto P, Vargas A, Aréchiga N. Surgical outcomes in patients with acromegaly: Microscopic vs. endoscopic transsphenoidal surgery. Best Pract Res Clin Endocrinol Metab 2024; 38:101879. [PMID: 38403492 DOI: 10.1016/j.beem.2024.101879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Transsphenoidal resection of growth hormone-secreting pituitary neuroendocrine tumors remains the first-line treatment for acromegaly. This can be performed through microsurgery or endoscopic surgery. For the past decades, endoscopic surgery has become the preferred technique in an increasing number of centers worldwide. However, whether it offers superior clinical outcomes has yet to be determined. In this paper, we performed a narrative review of the literature comparing both techniques in the treatment of acromegaly. We critically assessed available comparative studies from an objective perspective to determine their suitability for defining superiority of either technique. Available evidence displays substantial methodological variations and reports conflicting findings. Although endoscopic surgery provides a wider exposure and enhanced visibility of the surgical field, this does not consistently translate into better clinical outcomes, as most tumors are equally accessible through both techniques. Postoperative outcomes such as remission and complication rates are similar between both techniques. The management of acromegaly should be performed by experienced pituitary neurosurgeons, regardless of the approach. The involvement of a multidisciplinary team in a dedicated pituitary center is critical to ensure optimal outcomes.
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Affiliation(s)
- Gerardo Guinto
- Centro Medico ABC, Carlos Graef Fernández #154, Santa Fe, Cuajimalpa, 05300 Mexico City, Mexico
| | - Gerardo Y Guinto-Nishimura
- Hospital de Especialidades Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Cuauhtémoc, 06720 Mexico City, Mexico; Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía, Av. Insurgentes Sur 3877, Tlalpan, 14269 Mexico City, Mexico
| | - Rodrigo Uribe-Pacheco
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía, Av. Insurgentes Sur 3877, Tlalpan, 14269 Mexico City, Mexico
| | - Marcos V Sangrador-Deitos
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía, Av. Insurgentes Sur 3877, Tlalpan, 14269 Mexico City, Mexico
| | - Eliezer Villanueva-Castro
- Departamento de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía, Av. Insurgentes Sur 3877, Tlalpan, 14269 Mexico City, Mexico
| | - Ricardo García-Iturbide
- Hospital de Especialidades Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Cuauhtémoc, 06720 Mexico City, Mexico
| | - David Gallardo
- Hospital Ángeles del Pedregal, Periférico Sur 3697, Colonia Héroes de Padierna, 10700 Mexico City, Mexico
| | - Patricia Guinto
- Hospital Ángeles Clínica Londres, Durango 64, 06700 Mexico City, Mexico
| | - Alejandro Vargas
- Centro Medico ABC, Carlos Graef Fernández #154, Santa Fe, Cuajimalpa, 05300 Mexico City, Mexico
| | - Norma Aréchiga
- Centro Medico ABC, Carlos Graef Fernández #154, Santa Fe, Cuajimalpa, 05300 Mexico City, Mexico
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Hussein Z, Grieve J, Dorward N, Miszkiel K, Kosmin M, Fersht N, Bouloux PM, Jaunmuktane Z, Baldeweg SE, Marcus HJ. Non-functioning pituitary macroadenoma following surgery: long-term outcomes and development of an optimal follow-up strategy. Front Surg 2023; 10:1129387. [PMID: 37501881 PMCID: PMC10369001 DOI: 10.3389/fsurg.2023.1129387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/30/2023] [Indexed: 07/29/2023] Open
Abstract
Objectives Recurrence and regrowth of non-functioning pituitary macroadenomas (NFPMs) after surgery are common but remain unpredictable. Therefore, the optimal timing and frequency of follow-up imaging remain to be determined. We sought to determine the long-term surgical outcomes of NFPMs following surgery and develop an optimal follow-up strategy. Methods Patients underwent surgery for NFPMs between 1987 and 2018, with a follow-up of 6 months or more, were identified. Demographics, presentation, management, histology, imaging, and surgical outcomes were retrospectively collected. Results In total, 383 patients were included; 256 were men (256/383; 67%) with median follow-up of 8 years. Following primary surgery, 229 patients (229/383; 60%) achieved complete resection. Of those, 28 (28/229; 11%) developed recurrence, including six needed secondary surgery (6/229; 3%). The rate of complete resection improved over time; in the last quartile of cases, 77 achieved complete resection (77/95; 81%). Reoperation-free survival at 5, 10 and 15 years was 99%, 94% and 94%, respectively. NFPMs were incompletely resected in 154 patients (154/383; 40%); of those, 106 (106/154; 69%) had regrowth, and 84 (84/154; 55%) required reoperation. Surgical reintervention-free survival at 5, 10 and 15 years was 74%,49% and 35%, respectively. Young age and cavernous sinus invasion were risk factors for undergoing reoperation (P < 0.001 and P < 0.0001, respectively) and radiotherapy (P = 0.003 and P < 0.001, respectively). Patients with residual tumour required reoperation earlier than those underwent complete resection (P = 0.02). Radiotherapy to control tumour regrowth was delivered to 65 patients (65/383; 17%) after median time of 1 year following surgery. Radiotherapy was administered more in patients with regrowth of residual disease (61/106; 58%) than those who had NFPMs recurrence (4/28; 14%) (P ≤ 0.001) Following postoperative radiotherapy, one patient (1/65; 2%) had evidence of regrowth, seven (7/65; 11%) had tumour regression on imaging, and no patients underwent further surgery. Conclusions NFPMs recurrence and regrowth are common, particularly in patients with residual disease post-operatively. We propose a follow-up strategy based on stratifying patients as "low risk" if there is no residual tumour, with increasing scan intervals, or "high risk" if there is a residual tumour, with annual scans for at least five years and extended lifelong surveillance after that.
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Affiliation(s)
- Ziad Hussein
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- Department of Diabetes and Endocrinology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Joan Grieve
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Neil Dorward
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Katherine Miszkiel
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Michael Kosmin
- Department of Clinical Oncology, University College London Hospitals, London, United Kingdom
| | - Naomi Fersht
- Department of Clinical Oncology, University College London Hospitals, London, United Kingdom
| | - Pierre Marc Bouloux
- Centre for Neuroendocrinology, Royal Free Campus, University College Medical School, University College London, London, United Kingdom
| | - Zane Jaunmuktane
- Institute of Neurology, University College London, London, United Kingdom
| | - Stephanie E. Baldeweg
- Department of Diabetes and Endocrinology, University College London Hospital NHS Foundation Trust, London, United Kingdom
- Division of Medicine, Department of Experimental and Translational Medicine, Centre for Obesity and Metabolism, University College London, London, United Kingdom
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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Kelly AP, Greenfield JP, Dobri GA, Schwartz TH. Pediatric pituitary adenomas are more aggressive, more likely to be hormone producing and are more difficult to cure than adult pituitary adenomas: case series and systematic literature review. Childs Nerv Syst 2022; 38:729-738. [PMID: 35048170 DOI: 10.1007/s00381-022-05445-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Pediatric pituitary adenomas (pPAs) are uncommon. Thus, their presentation and outcomes after treatment are less well-understood than those of pituitary adenomas in adulthood (aPAs). METHODS A retrospective chart review was conducted for all patients who underwent endoscopic endonasal transsphenoidal surgery (EETS) for pPA at NewYork-Presbyterian Hospital/Weill Cornell Medicine (NYP/WCM) from 2005-2020. Eleven patients were identified, and information pertaining to age, sex, adenoma characteristics, procedural details, and outcomes was reviewed. A systematic review of the literature was also performed to compare outcomes of EETS versus microscopic endonasal transsphenoidal surgery (METS) for pPA. RESULTS From 2005-2020, 11 patients underwent EETS for pPA at NYP/WCM. Mean age at operation was 14.9 ± 2.7 years, and 5 patients (45.5%) were male. 10 adenomas (90.9%) were hormone-producing. Of the functional adenomas, 8 (80.0%) were PRL-secreting and 2 (20.0%) were GH-secreting. Maximum adenoma diameter (MAD) ranged from 1.2-5.1 cm, with a median of 1.55 cm. Cavernous sinus invasion (CSI) occurred in 2 patients with macroprolactinoma. Gross total resection (GTR) was achieved in 10 (90.9%). Biochemical remission occurred in 5/10 (50.0%). Post-operative complications were documented in 8 cases (72.7%) and included diabetes insipidus, hypopituitarism, sinusitis, weight gain, cerebrospinal fluid leak, meningitis, and hydrocephalus. Systematic literature review of 105 microscopic and 175 endoscopic cases revealed high frequency of hormone-producing tumors (83.6%) and similar rates of GTR (82.4% vs 85.1%) and biochemical cure (75.8% vs 64.3%). CONCLUSIONS pPAs are more likely to be hormone producing and may be more aggressive and difficult to cure than aPAs. EETS is an effective treatment, although complication rates may be higher than in adult populations.
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Affiliation(s)
- Alexander P Kelly
- Weill Cornell Medical College, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey P Greenfield
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Georgiana A Dobri
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY, USA.
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Chen J, Liu H, Man S, Liu G, Li Q, Zuo Q, Huo L, Li W, Deng W. Endoscopic vs. Microscopic Transsphenoidal Surgery for the Treatment of Pituitary Adenoma: A Meta-Analysis. Front Surg 2022; 8:806855. [PMID: 35187049 PMCID: PMC8847202 DOI: 10.3389/fsurg.2021.806855] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
PurposeCurrently, endoscopic transsphenoidal surgery (ETS) and microscopic transsphenoidal surgery (MTS) are commonly applied treatments for patients with pituitary adenomas. This meta-analysis was conducted to evaluate the efficacy and safety of ETS and MTS for these patients.MethodsA computer search of Pubmed, Embase, Cochrane library, Web of Science, and Google Scholar databases was conducted for studies investigating ETS and MTS for patients with pituitary adenomas. The deadline is March 01, 2021. RevMan5.1 software was used to complete this meta-analysis after literature screening, data extraction, and literature quality evaluation.ResultsA total of 37 studies including 5,591 patients were included. There was no significant difference in gross tumor removal (GTR) and hormone-excess secretion remission (HES remission) between two groups [RR = 1.10, 95% CI (0.99–1.22), P = 0.07; RR = 1.09, 95% CI (1.00–1.20), P = 0.05]. ETS was associated with lower incidence of diabetes insipidus (DI) [RR = 0.71, 95% CI (0.58–0.87), P = 0.0008], hypothyroidism [RR = 0.64, 95% CI (0.47–0.89), P = 0.007], and septal perforation [RR = 0.32, 95% CI (0.13–0.79), P = 0.01] than those with MTS.ConclusionThis meta-analysis indicated that ETS cannot significantly improve GTR and HES remission. However, ETS could reduce the incidence of DI, hypothyroidism, and septal perforation without increasing the rate of other complications.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/#myprospero, identifier: CRD42021241217.
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Affiliation(s)
- Jia Chen
- Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, China
| | - Hongyan Liu
- Department of Endocrinology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Siliang Man
- Department of Rheumatology, Beijing Jishuitan Hospital, Beijing, China
| | - Geng Liu
- Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, China
- Department of Emergency, Beijing Jishuitan Hospital, Beijing, China
| | - Quan Li
- Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, China
| | - Qingyao Zuo
- Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, China
| | - Lili Huo
- Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Li
- Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Deng
- Department of Endocrinology, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Wei Deng
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Guo S, Wang Z, Kang X, Xin W, Li X. A Meta-Analysis of Endoscopic vs. Microscopic Transsphenoidal Surgery for Non-functioning and Functioning Pituitary Adenomas: Comparisons of Efficacy and Safety. Front Neurol 2021; 12:614382. [PMID: 33833725 PMCID: PMC8021708 DOI: 10.3389/fneur.2021.614382] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/23/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Although microscopic (MTSS) and endoscopic transsphenoidal surgery (ETSS) are both effective approaches for treating non-functioning pituitary adenomas (NFPA) and functioning pituitary adenomas (FPA), the consensus remains unidentified on whether there are differences in the risk of postoperative complications between the two surgical approaches. Method: A meta-analysis of the study of MTSS vs. ETSS for NFPA and FPA was conducted by searching the electronic databases of PubMed, Cochrane Library, and EMBASE, from the date of establishment of electronic databases to September 2020 based on the PRISMA guidelines. Results: In this study, a total of 16 studies were selected, hailing from Belgium, the USA, India, Finland, France, Korea, Spain, China, and Canada. We enrolled 1003 patients in the ETSS and 992 patients in the MTSS group. In patients with NFPA, the ETSS group was related to a higher incidence of post-operative gross-total resection (GTR). (OR = 1.655, 95% CI 1.131–2.421, P = 0.010). In participants with FPA, the results illustrated that the ETSS group had higher rates of visual improvement (OR = 2.461, 95% CI 1.109–5.459) and gross-total resection (OR = 2.033, 95% CI 1.335–3.096), as well as lower meningitis rates (OR = 0.195, 95% CI 0.041–1.923). In participants with acromegaly, no significant difference was shown in the postoperative complications. Conclusion: Based on current evidence, participants with NFPA treated by endoscopy were related to higher rates of GTR; patients with FPA treated by ETSS were related to higher rates of visual improvement and GTR, as well as a lower rates of meningitis.
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Affiliation(s)
- Shengfu Guo
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Zidong Wang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Xiaokui Kang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
| | - Wenqiang Xin
- Department of Neurology, University Medical Center Goettingen, Göttingen, Germany.,Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Li
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, China
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Chen X, Huang W, Li H, Huan Y, Mai G, Chen L, Huang H, Xu H. Comparison of outcomes between endoscopic and microscopic transsphenoidal surgery for the treatment of pituitary adenoma: a meta-analysis. Gland Surg 2020; 9:2162-2174. [PMID: 33447567 DOI: 10.21037/gs-20-851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Pituitary tumors are among the most common intracranial tumors. Surgical resection is the most effective treatment for patients with pituitary tumors. Microscopic transsphenoidal surgery has become the first-choice surgical approach to treating this malignancy, although it has certain limitations. Neuroendoscopy has also been widely used for pituitary tumor surgery in recent years. This study aimed to compare the efficacy and safety of these two surgical options for the treatment of pituitary tumors. Methods We conducted a literature search of the PubMed, Embase, Cochrane Controlled Center Register of Controlled Trials (CENTRAL), Web of Science database, Google Scholar, and Baidu Scholar. Relevant articles published up to September 25, 2020 were retrieved and then meta-analyzed using RevMan software 5.1. Results A total of 29 case-control studies involving 7,774 patients were included in the meta-analysis. There was no significant difference in gross tumor removal (GTR) (RR =1.11, 95% CI: 0.97-1.26, P=0.12) or hormone excess secretion (HES) remission (RR =1.08, 95% CI: 0.97-1.21, P=0.16) between the two groups. Endoscopic transsphenoidal surgery was associated with a lower incidence of diabetes insipidus (DI) than was microscopic transsphenoidal surgery (RR =0.76, 95% CI: 0.60-0.97, P=0.03). Conclusions Endoscopic transsphenoidal surgery does not significantly improve GTR or HES remission, but it can reduce the incidence of DI without increasing the rates of other complications.
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Affiliation(s)
- Xiaolin Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wei Huang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hongjuan Li
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yan Huan
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoying Mai
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Luming Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hongqiang Huang
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haoxiang Xu
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
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Castaño-Leon AM, Paredes I, Munarriz PM, Jiménez-Roldán L, Hilario A, Calatayud M, Hernandez-Lain A, Garcia E, Garcia A, Lagares A, Alén JF. Endoscopic Transnasal Trans-Sphenoidal Approach for Pituitary Adenomas: A Comparison to the Microscopic Approach Cohort by Propensity Score Analysis. Neurosurgery 2020; 86:348-356. [PMID: 31173138 DOI: 10.1093/neuros/nyz201] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 01/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite some evidence for the adoption of endoscopic transnasal trans-sphenoidal surgery (ETSS) for pituitary adenomas, the advantages of this technique over the traditional approach have not been robustly confirmed. OBJECTIVE To compare ETSS with the microscopic sublabial trans-septal trans-sphenoidal surgery (MTSS) for pituitary adenomas. METHODS We retrospectively reviewed 2 cohorts of ETSS and MTSS performed at our institution from 1995 to 2017. Patient characteristics, surgical data, and outcomes were recorded prospectively. We performed a univariate and multivariable analysis to determine the best surgical approach. To improve the quality of the results, we matched the distribution of patient characteristics between groups by propensity score (PS) method. RESULTS A total of 187 procedures (90 MTSS, 97 ETSS) were reviewed. We found better results in the ETSS group in terms of gross total resection (P = .002) and hormone-excess secretion control (P = .014). There was also a lower incidence of cerebrospinal fluid leakage (P = .039), transitory diabetes insipidus (P = .028), and postoperative hypopituitarism (P = .045), as well as a shorter hospital length of stay (P < .001). After PS matching, we confirmed by multivariable logistic regression analysis an increased odds ratio of gross total resection for the ETSS (3.910; 95% CI 1.720-8.889; P = .001). CONCLUSION By PS method, our results suggest that the ETSS provides advantages over the traditional MTSS approach for tumor resection. Better control of secreting tumors and a lower rate of most complications also support the selection of the ETSS approach for the treatment of pituitary adenomas.
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Affiliation(s)
- Ana M Castaño-Leon
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Igor Paredes
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Pablo M Munarriz
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Jiménez-Roldán
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Amaya Hilario
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria Calatayud
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Aurelio Hernandez-Lain
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Ester Garcia
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfredo Garcia
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose F Alén
- Department of Neurosurgery, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
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Dai W, Zhuang Z, Ling H, Yang Y, Hang C. Systematic review and network meta-analysis assess the comparative efficacy and safety of transsphenoidal surgery for pituitary tumor. Neurosurg Rev 2020; 44:515-527. [PMID: 32036504 DOI: 10.1007/s10143-020-01240-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 12/27/2022]
Abstract
To quantitatively synthesize the comparative efficacy and safety of the most common surgical approaches including endonasal transsphenoidal endoscopic surgery (ETES), sublabial transsphenoidal microsurgery (STMS) and endonasal transsphenoidal microsurgery (ETMS) for all kinds of pituitary tumors. This systematic review and network meta-analysis was performed on randomized controlled trials (RCTs) and comparison studies from databases of Pubmed, EMBASE, and the Cochrane library. We selected the rate of gross complete resection as our primary outcome of efficacy. And the incidence of all complications, cerebrospinal fluid (CSF) leak, diabetes insipidus, nasal septal perforation, death, and bleeding were designed as our primary outcomes of safety. Twenty-seven studies with 2618 patients were included in this network meta-analysis. On efficacy, there was no statistical difference among the three methods including ETES, STMS, and ETMS. As for safety, results indicated that the incidence of total complications of STMS (OR = 4.74; 95% CI 1.03, 40.14) is significantly superior to ETES. And the incidence of diabetes insipidus of ETMS (OR = 2.21; 95% CI 1.31, 3.81) was significantly superior to that of ETES. Besides, there was no statistical difference in the other complications including CSF leak, nasal septal perforation, death, and bleeding. We clarified the overpraise of the efficacy of endoscopy especially the endonasal transsphenoidal approach, and verified that all the approaches owned similar efficacy. Moreover, we recommended the endoscopy to be the first choice for pituitary tumors, because it demonstrated the best safety.
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Affiliation(s)
- Wei Dai
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210000, China
| | - Zong Zhuang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210000, China
| | - Haiping Ling
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210000, China
| | - Yongbo Yang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210000, China
| | - Chunhua Hang
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, 210000, China.
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Phogat V, Agarwal M, Sinha VD, Purohit D. Comparative Efficacy of Transsphenoidal Endonasal Endoscopic and Microscopic Pituitary Surgery at Single Center of a Developing Country. J Neurol Surg B Skull Base 2020; 82:e88-e93. [PMID: 34306921 DOI: 10.1055/s-0039-3402041] [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: 06/01/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022] Open
Abstract
Objective This study was aimed to compare comparative efficacy of transsphenoidal endonasal endoscopic and microscopic pituitary surgery at single center of a developing country. Methods This study included 198 patients in which 50 patients were studied prospectively and 148 patients were studied retrospectively, diagnosed with pituitary adenoma who presented to neurosurgery department at Sawai Man Singh hospital in Jaipur, India, and were operated via transsphenoidal route between 2013 and 2018. Patients' records were reviewed and relevant clinical and surgical data were collected. Patients were divided into two groups based on the surgical procedure performed, endoscopic endonasal transsphenoid approach (group 1) and microscopic transsphenoidal approach (group 2). Outcomes, in terms of efficacy and the resulting complications of each procedure were compared and analyzed. Results A total of 198 patients with pituitary adenoma were operated during the study period. Among them, 119 (60.1%) patients were operated by endoscopic and 79 (39.9%) patients were operated by microscopic transsphenoidal approach. In endoscopic group, intraoperative cerebrospinal fluid (CSF) leak was present in 39 patients (32.77%) and 23 (29.11%) in microscopic group. Complete tumor removal was achieved in 69.75% in endoscopic and 48.13% in microscopic group ( p = 0.004). Endocrine control was achieved in 78.94% (30 out of 38) in endoscopic and 68.18% (15 out of 22 patients) in microscopic group. Conclusion The transsphenoidal approaches for resection of pituitary adenoma, both endoscopic and microscopic approach, are minimally invasive and effective for disease control. Both the approaches lead to similar endocrine control, visual symptoms, complications, and long-term outcome. Therefore, the selection of the final approach should be individualized, ultimately depending on the surgeons' comfort, experience, and familiarity with the particular technique.
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Affiliation(s)
- Vivek Phogat
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Manish Agarwal
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Virendra D Sinha
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Devendra Purohit
- Department of Neurosurgery, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
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Comparison of Short-Term Outcomes Between Endoscopic and Microscopic Trans-Sphenoidal Surgery for the Treatment of Pituitary Adenoma. J Craniofac Surg 2020; 30:2421-2424. [PMID: 31261331 DOI: 10.1097/scs.0000000000005676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Until today, it is unclear if endoscopic or microscopic transsphenoidal surgery is the most adequate treatment technique for pituitary adenoma, while microscopic transsphenoidal surgery is termed as a fully-established mechanism that has reasonable performances and is well recognized for addressing adenomas of the pituitary gland. The present research work aims at assessing the short-term results of these surgical methodologies in those patients, who have pituitary adenoma. METHODS The authors comprehensively searched PubMed, together with EMBASE, and Cochrane Library databases for the purpose of identifying associated investigations. The strength of the relationship was figured out through the calculation of the risk ratio (RR) with corresponding 95% credible interval (95% CI) were put to use for the evaluation of the association. RESULTS An aggregate of 17 retrospective studies that involved 1177 participants were included in the present research work. Our results shed light on the fact that endoscopic transsphenoidal surgery was linked to the lower occurrence of diabetes insipidus (RR = 1.42, 95%CI = 1.03-1.98, P = 0.03), fewer septal perforation (RR = 3.16, 95%CI = 1.27-7.85, P = 0.01), and fewer postoperative complications (RR = 1.29, 95% CI = 1.08-1.56, P = 0.006). Moreover, further analyzing indicated no substantial differences existing between the 2 surgical methods in gross tumor removal, meningitis, epistaxis, and cerebrospinal fluid leak. CONCLUSION Endoscopic transsphenoidal surgery reduces diabetes insipidus, septal perforation, and postoperative complications in treating those patients, who have pituitary adenoma. Endoscopic transsphenoidal surgery is worth suggesting as a productive as well as secure process for the treatment of pituitary adenoma.
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Li K, Zhang J, Wang XS, Ye X, Zhao YL. A systematic review of effects and complications after transsphenoidal pituitary surgery: endoscopic versus microscopic approach. MINIM INVASIV THER 2019; 29:317-325. [PMID: 31495241 DOI: 10.1080/13645706.2019.1660369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Microscopic transsphenoidal surgery (MTS) has been considered as the gold standard for transsphenoidal pituitary surgery, but nowadays endoscopic transsphenoidal surgery (ETS) has become popular due to its wide view and improved lighting.Material and methods: The electronic databases were systematically searched, and the meta-analyses of the eligible studies that evaluated endoscopic versus microscopic methods in patients with pituitary surgery were conducted with Review Manager 5.0. The primary outcomes included visual improvement, gross tumor removal (GTR), cerebrospinal fluid (CFS) leak, diabetes insipidus (DI), other complications, and length of hospital stay. The Egger's test was conducted to estimate possible publication bias.Results: In total, 13 articles eventually met the inclusion criteria. The meta-analyses suggested that the differences with regard to visual improvement, overall complication rate, GTR, CSF leak, diabetes insipidus (DI), meningitis, visual impairment, syndrome of inappropriate antidiuretic hormone secretion (SIADH), new onset hypopituitarism, and hypothyroidism between the endoscopic and microscopic groups were not statistically significant. The length of hospital stay was much longer with the microscopic approach when compared with the endoscopic method.Conclusion: The endoscopic and microscopic approaches show similar effects and complication rates. The endoscopic technique could be adopted as a reasonable alternative in pituitary surgery.
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Affiliation(s)
- Kai Li
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Jun Zhang
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Xin-Sheng Wang
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Xun Ye
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yuan-Li Zhao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
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Broersen LHA, van Haalen FM, Biermasz NR, Lobatto DJ, Verstegen MJT, van Furth WR, Dekkers OM, Pereira AM. Microscopic versus endoscopic transsphenoidal surgery in the Leiden cohort treated for Cushing's disease: surgical outcome, mortality, and complications. Orphanet J Rare Dis 2019; 14:64. [PMID: 30866993 PMCID: PMC6416951 DOI: 10.1186/s13023-019-1038-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/28/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND First-choice treatment for Cushing's disease is transsphenoidal adenomectomy. Since its introduction in the 1970s, many centers have now switched from microscopic to endoscopic surgery. We compared both techniques for the treatment of Cushing's disease at the Leiden University Medical Center, a European reference center for pituitary diseases. METHODS Cohort study with inclusion and follow-up of consecutive Cushing's disease patients primarily treated by transsphenoidal surgery at the Leiden University Medical Center between 1978 and 2016. We compared remission rates (primary endpoint), mortality, and complications between microscopic (performed up to 2005) and endoscopic (performed from 2003 onwards) surgery. Subgroup analyses were performed by tumor size, surgical experience, and preoperative imaging techniques. Additionally, surgeons' intraoperative findings regarding presence and removal of the adenoma were related to surgical outcome. RESULTS Of 137 included patients, 87 were treated microscopically and 50 endoscopically. Three months after microscopic surgery, 74 patients (86%) were in remission. Five-year recurrence-free survival was 89% (95% confidence interval [CI]: 82-96%), and ten-year recurrence free survival was 84% (95% CI: 75-93%). After endoscopic surgery, 39 patients (83%) were in remission. Both five-year and ten-year recurrence-free survival were 71% (95% CI: 55-87%). Hazard ratio for recurrence was 0.47 (95% CI: 0.19-1.14), and for mortality 2.79 (95% CI: 0.35-22.51), for microscopic versus endoscopic surgery. No learning curve was found for endoscopy, nor an influence of preoperative imaging technique for microscopy. In addition, we did not find a clear relation between the surgeons' intraoperative findings and surgical outcomes. CONCLUSIONS This study did not identify a clear advantage of microscopic or endoscopic transsphenoidal surgery for the treatment of Cushing's disease based on clinical outcome. The transition to endoscopic surgery at our center was not accompanied by transient worsening of outcomes, which may be reassuring for those considering transitioning.
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Affiliation(s)
- Leonie H. A. Broersen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Femke M. van Haalen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Nienke R. Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Daniel J. Lobatto
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Marco J. T. Verstegen
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Wouter R. van Furth
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Olaf M. Dekkers
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Alberto M. Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Broersen LHA, Biermasz NR, van Furth WR, de Vries F, Verstegen MJT, Dekkers OM, Pereira AM. Endoscopic vs. microscopic transsphenoidal surgery for Cushing's disease: a systematic review and meta-analysis. Pituitary 2018; 21:524-534. [PMID: 29767319 PMCID: PMC6132967 DOI: 10.1007/s11102-018-0893-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE Systematic review and meta-analysis comparing endoscopic and microscopic transsphenoidal surgery for Cushing's disease regarding surgical outcomes (remission, recurrence, and mortality) and complication rates. To stratify the results by tumor size. METHODS Nine electronic databases were searched in February 2017 to identify potentially relevant articles. Cohort studies assessing surgical outcomes or complication rates after endoscopic or microscopic transsphenoidal surgery for Cushing's disease were eligible. Pooled proportions were reported including 95% confidence intervals. RESULTS We included 97 articles with 6695 patients in total (5711 microscopically and 984 endoscopically operated). Overall, remission was achieved in 5177 patients (80%), with no clear difference between both techniques. Recurrence was around 10% and short term mortality < 0.5% for both techniques. Cerebrospinal fluid leak occurred more often in endoscopic surgery (12.9 vs. 4.0%), whereas transient diabetes insipidus occurred less often (11.3 vs. 21.7%). For microadenomas, results were comparable between both techniques. For macroadenomas, the percentage of patients in remission was higher after endoscopic surgery (76.3 vs. 59.9%), and the percentage recurrence lower after endoscopic surgery (1.5 vs. 17.0%). CONCLUSIONS Endoscopic surgery for patients with Cushing's disease reaches comparable results for microadenomas, and probably better results for macroadenomas than microscopic surgery. This is present despite the presumed learning curve of the newer endoscopic technique, although confounding cannot be excluded. Based on this study, endoscopic surgery may thus be considered the current standard of care. Microscopic surgery can be used based on neurosurgeon's preference. Endocrinologists and neurosurgeons in pituitary centers performing the microscopic technique should at least consider referring Cushing's disease patients with a macroadenoma.
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Affiliation(s)
- Leonie H A Broersen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Wouter R van Furth
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Friso de Vries
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Marco J T Verstegen
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Center for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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López-García R, Abarca-Olivas J, Monjas-Cánovas I, Picó Alfonso A, Moreno-López P, Gras-Albert JR. [Endonasal endoscopic surgery in pituitary adenomas: Surgical results in a series of 86 consecutive patients]. Neurocirugia (Astur) 2018; 29:161-169. [PMID: 29580720 DOI: 10.1016/j.neucir.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 01/26/2018] [Accepted: 02/03/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The endoscopic endonasal approach has become the gold standard for the surgical treatment of pituitary adenomas. OBJECTIVES The aim of this study is to present the results obtained in our hospital in purely endoscopic surgery of pituitary adenomas. METHODS From February 2011 to August 2016, we conducted a prospective study on a series of 86 patients with pituitary adenoma, all of whom underwent surgery with a purely endoscopic endonasal approach. The 'four hands-two nostrils' technique was performed in all cases by a surgical team composed of an ENT surgeon and a neurosurgeon. Mean follow-up was 32 months. All patients were evaluated according to clinical, radiological and endocrinological criteria. RESULTS In our series, 53% were women and 47% men. The age ranged from 14 to 84 years of age, with a mean of 54 years of age. The most common initial symptom was visual deficit (42%), followed by hormonal hyperfunction (21%), with acromegaly being the most common clinical syndrome. The most common tumours were non-functioning tumours (73%), while GH-secreting tumours (65%) were the most common functioning adenoma. Regarding tumour size, 76% were macroadenomas, 11% microadenomas and 13% giant adenomas. Approximately 63% of the adenomas exhibited suprasellar extension and 37% involved invasion of the cavernous sinus (Knosp grade ≥3). Total excision was achieved in 77% of the cases. After the intervention, visual improvement was achieved in 91% and remission of endocrine hyperfunction in up to a 73% of cases. The most common complication was anterior pituitary insufficiency of at least one axis (9%). There were no cases of postoperative cerebrospinal fluid fistula. CONCLUSIONS In terms of surgical quality, our results are similar to those of published series, and demonstrate the efficacy and safety of the endoscopic endonasal approach as the surgical treatment of choice for pituitary adenomas. However, further studies with a higher sample size are necessary to obtain clinically significant results.
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Affiliation(s)
- Raquel López-García
- Servicio de Neurocirugía, Hospital General Universitario de Alicante, Alicante, España.
| | - Javier Abarca-Olivas
- Servicio de Neurocirugía, Hospital General Universitario de Alicante, Alicante, España
| | - Irene Monjas-Cánovas
- Servicio de Otorrinolaringología, Hospital General Universitario de Alicante, Alicante, España
| | - Antonio Picó Alfonso
- Servicio de Endocrinología, Hospital General Universitario de Alicante, Alicante, España
| | - Pedro Moreno-López
- Servicio de Neurocirugía, Hospital General Universitario de Alicante, Alicante, España
| | - Juan Ramón Gras-Albert
- Servicio de Otorrinolaringología, Hospital General Universitario de Alicante, Alicante, España
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Efficacy of Microsurgical Sublabial Approach (MSA) Versus Endoscopic Endonasal Approach (EEA) for the Treatment of Pituitary Adenomas Based on Radiological and Hormonal Outcome. ACTA NEUROCHIRURGICA. SUPPLEMENT 2017; 124:101-106. [PMID: 28120060 DOI: 10.1007/978-3-319-39546-3_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The purpose of this study was to compare the surgical efficacy of the microsurgical sublabial approach (MSA) versus the endoscopic endonasal approach (EEA) for the treatment of pituitary adenomas, based on short-term (12 months) radiological and endocrinological follow-up. METHODS One hundred and fourteen patients affected by pituitary adenoma were enrolled at our Unit between January 2007 and February 2012; 72 were treated with MSA, and 42 with EEA. The preoperative parameters considered were: type of lesion (secreting or nonsecreting), lesion size, presence of intralesional hemorrhage, lesion perimeter (nodular vs. uniform), intrasellar vs. suprasellar, involvement of cavernous sinus, and osteodural infiltration. Hormonal assays and magnetic resonance imaging (MRI) scans were performed at 12 months after the surgical procedure. RESULTS Univariate analysis of the data documented a statistically significant difference in favor of MSA for the subgroups of secreting adenomas (90.9 % vs. nonsecreting 48.3 %), microadenomas (100 % vs. macroadenomas 57.1 %), adenomas without osteodural infiltration (87.5 % vs. 55.5 % with the infiltration) or those without intralesional hemorrhage (75 % vs. 45.9 % with the hemorrhage), and growth hormone (GH) adenomas (88.8 % vs. 43.7 %). Multivariate analysis confirmed the greater effectiveness of MSA for the treatment of micro-secreting adenomas. CONCLUSIONS Recent advances in the EEA for treating pituitary adenomas could lead to this modality replacing the microsurgical technique. In our experience the MSA allowed us to achieve better results in the treatment of microadenomas.
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Qureshi T, Chaus F, Fogg L, Dasgupta M, Straus D, Byrne RW. Learning curve for the transsphenoidal endoscopic endonasal approach to pituitary tumors. Br J Neurosurg 2016; 30:637-642. [PMID: 27332969 DOI: 10.1080/02688697.2016.1199786] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The transsphenoidal endoscopic approach is a relatively new procedure compared to the microscopic approach in pituitary adenoma resection. The endoscopic approach has shown to significantly decrease the rate of complications, time in the operating room and hospital, and patient post-op discomfort. However, this procedure requires the surgeon to make use of different visual and tactile clues that must be developed with experience. Therefore, it is important to understand the learning curve that the surgeon must overcome to become proficient with the endoscopic approach. METHODS Retrospective review of a single-surgeon consecutive series of 78 patients undergoing endoscopic pituitary tumor surgery from 2006 to 2012 at Rush University Medical Center has been used in this study. Patients were grouped according to an early (n = 9) and late group (n = 68) determined by a significant difference in outcomes. Our primary outcome measures were: duration of operation, CSF leak, hospital length of stay, visual field improvement, diabetes insipidus, panhypopituitarism, and subtotal resection. RESULTS There was a significant reduction in OR time and intraoperative CSF leaks between the early and late groups. There was no difference in hospital LOS or visual field improvement between the groups. With regards to complication rates, there was no difference found for DI, panhypopituitarism, lumbar drain placement, sinusitis, or subtotal resection between the two groups. CONCLUSION This study indicates that there may be a learning curve of approximately 9 cases before a surgical team can decrease OR times and reduce the rate of intraoperative CSF leaks for the endonasal endoscopic approach to pituitary adenoma resection.
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Affiliation(s)
- Talha Qureshi
- a Rush University Medical Center , Chicago , IL , USA
| | - Fahad Chaus
- a Rush University Medical Center , Chicago , IL , USA
| | - Louis Fogg
- a Rush University Medical Center , Chicago , IL , USA
| | - Mona Dasgupta
- a Rush University Medical Center , Chicago , IL , USA
| | - David Straus
- b Department of Neurosurgery , Rush University Medical Center , Chicago , IL , USA
| | - Richard W Byrne
- b Department of Neurosurgery , Rush University Medical Center , Chicago , IL , USA
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Theodros D, Patel M, Ruzevick J, Lim M, Bettegowda C. Pituitary adenomas: historical perspective, surgical management and future directions. CNS Oncol 2015; 4:411-29. [PMID: 26497533 DOI: 10.2217/cns.15.21] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Pituitary adenomas are among the most common central nervous system tumors. They represent a diverse group of neoplasms that may or may not secrete hormones based on their cell of origin. Epidemiologic studies have documented the incidence of pituitary adenomas within the general population to be as high as 16.7%. A growing body of work has helped to elucidate the pathogenesis of these tumors. Each subtype has been shown to demonstrate unique cellular changes potentially leading to tumorigenesis. Surgical advancements over several decades have included microsurgery and the employment of the endoscope for surgical resection. These advancements increase the likelihood of gross-total resection and have resulted in decreased patient morbidity.
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Affiliation(s)
- Debebe Theodros
- The Johns Hopkins University School of Medicine, The Johns Hopkins University Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mira Patel
- The Johns Hopkins University School of Medicine, The Johns Hopkins University Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jacob Ruzevick
- The Johns Hopkins University School of Medicine, The Johns Hopkins University Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael Lim
- The Johns Hopkins University School of Medicine, The Johns Hopkins University Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Chetan Bettegowda
- The Johns Hopkins University School of Medicine, The Johns Hopkins University Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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Mamelak AN. Pro: endoscopic endonasal transsphenoidal pituitary surgery is superior to microscope-based transsphenoidal surgery. Endocrine 2014; 47:409-14. [PMID: 24858627 DOI: 10.1007/s12020-014-0294-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/08/2014] [Indexed: 12/26/2022]
Abstract
The introduction of the endoscope to transsphenoidal pituitary surgery is relatively new, but represents a major advancement in the field. The use of the endoscope to visualize the sella via a direct endonasal approach offers the surgeon dramatically better visualization as well as improved range of motion compared to the operating microscope. Growing evidence confirms that these improvements directly translate into better surgical resections and outcomes. Further, patient comfort and satisfaction are higher with the endonasal method compared with other transsphenoidal approaches, and it is a cost effective technology. This position paper will outline the reasons that endoscopic endonasal transsphenoidal surgery is the preferred method for pituitary surgery, and why it will likely be adopted as the standard technique for transsphenoidal surgery worldwide.
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Affiliation(s)
- Adam N Mamelak
- Department of Neurosurgery, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Suite A6600, Los Angeles, CA, 90048, USA,
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Zimmer LA, Shah O, Theodosopoulos PV. Short-Term Quality-of-Life Changes after Endoscopic Pituitary Surgery Rated with SNOT-22. J Neurol Surg B Skull Base 2014; 75:288-92. [PMID: 25093153 DOI: 10.1055/s-0034-1372464] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 01/30/2014] [Indexed: 10/25/2022] Open
Abstract
Objective Little data exist on short-term quality-of-life (QOL) outcomes, specifically sinonasal measures, after endoscopic pituitary surgery. Design Prospective case series assessed sinonasal QOL before and after the transnasal endoscopic approach to the sella with resection of nasal cavity and sinus tissues. Setting/Participants/Main Outcome Measures A total of 39 adults scheduled to undergo resection for a pituitary mass preoperatively completed the Sinonasal Outcome Test-22 (SNOT-22). Rating various QOL issues, testing repeated postoperatively at 1 month by 37 patients and 3 months by 35 patients, was analyzed (paired Student t test). Results SNOT-22 scores (5-point scale; total: 110) averaged 23.4 preoperatively and 27.6 at 1 month but had significantly improved to 16.2 at 3 months (p = 0.03). Emotional well-being parameters (e.g., sadness, frustration, concentration, productivity, fatigue) significantly improved 3 months postoperatively (p < 0.05). Physiologic parameters (e.g., olfaction, obstruction, postnasal drainage) that had worsened at 1 month (< 0.05) then normalized at 3 months. Conclusion Total ratings for sinonasal QOL shows that SNOT scores were comparable between preoperative and 1-month testing but were improved significantly at 3 months. Individual questions showed marked improvement in emotional well-being and temporary physiologic changes after surgery. Our findings give surgeons information about what patients can expect immediately after transnasal endoscopic pituitary surgery.
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Affiliation(s)
- Lee A Zimmer
- Departments of Otolaryngology, Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, United States ; Neurosensory Disorders Center, UC Neuroscience Institute, Cincinnati, Ohio, United States
| | - Ojas Shah
- Departments of Otolaryngology, Head and Neck Surgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, United States ; Neurosensory Disorders Center, UC Neuroscience Institute, Cincinnati, Ohio, United States
| | - Phillip V Theodosopoulos
- Neurosensory Disorders Center, UC Neuroscience Institute, Cincinnati, Ohio, United States ; Departments of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, United States ; Mayfield Clinic, Cincinnati, Ohio, United States
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Gao Y, Zhong C, Wang Y, Xu S, Guo Y, Dai C, Zheng Y, Wang Y, Luo Q, Jiang J. Endoscopic versus microscopic transsphenoidal pituitary adenoma surgery: a meta-analysis. World J Surg Oncol 2014; 12:94. [PMID: 24721812 PMCID: PMC3991865 DOI: 10.1186/1477-7819-12-94] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 03/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endoscopic transsphenoidal surgery has gradually come to be regarded as a preferred option in the treatment of pituitary adenomas because of its advantages of improved visualization and its minimal invasiveness. The aim of this study was to compare and evaluate the outcomes and complications of endoscopic and microscopic transsphenoidal surgery in the treatment of pituitary adenomas. METHODS We performed a systematic literature search of MEDLINE, EMBASE, the Cochrane Library and the Web of Science between January 1992 and May 2013. Studies with consecutive patients that explicitly and fully compared endoscopic and microscopic approaches in the treatment of pituitary adenomas were included. RESULTS A total of 15 studies (n = 1,014 patients) met the inclusion criteria among 487 studies that involved endoscopic surgery and 527 studies that dealt with microscopic surgery. The rate of gross tumor removal was higher in the endoscopic group than in the microscopic group. The post-operative rates of septal perforation were less frequent in patients who underwent endoscopic surgery. There was no significant difference between the two techniques in the incidence rates of meningitis, diabetes insipidus, cerebrospinal fluid leak, epistaxis or hypopituitarism. The post-operative hospital stay was significantly shorter for the endoscopic surgery group compared with the microscopic surgery group (P < 0.05). There was no significant difference in the length of the operation (P > 0.05). CONCLUSIONS The present study indicates that the endoscopic transsphenoidal approach is safer and more effective than microscopic surgery in the treatment of pituitary adenomas.
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Affiliation(s)
| | - Chunlong Zhong
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
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Affiliation(s)
- Theodore H Schwartz
- Departments of Neurosurgery, Otolaryngology, Neurology, and Neuroscience, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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Schreckinger M, Szerlip N, Mittal S. Diabetes insipidus following resection of pituitary tumors. Clin Neurol Neurosurg 2013; 115:121-6. [DOI: 10.1016/j.clineuro.2012.08.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 07/16/2012] [Accepted: 08/04/2012] [Indexed: 10/28/2022]
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Baddour HM, Lupa MD, Patel ZM. Comparing use of the Sonopet®ultrasonic bone aspirator to traditional instrumentation during the endoscopic transsphenoidal approach in pituitary tumor resection. Int Forum Allergy Rhinol 2013; 3:588-91. [DOI: 10.1002/alr.21143] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/06/2012] [Accepted: 10/19/2012] [Indexed: 11/12/2022]
Affiliation(s)
- H. Michael Baddour
- Department of Otolaryngology-Head and Neck Surgery; Emory University School of Medicine; Atlanta; GA
| | - Michael D. Lupa
- Department of Otolaryngology-Head and Neck Surgery; Emory University School of Medicine; Atlanta; GA
| | - Zara M. Patel
- Department of Otolaryngology-Head and Neck Surgery; Emory University School of Medicine; Atlanta; GA
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Ajler P, Hem S, Goldschmidt E, Landriel F, Campero A, Yampolsky C, Carrizo A. [Endoscopic transnasal surgery for pituitary adenomas]. Surg Neurol Int 2012; 3:S389-94. [PMID: 23596553 PMCID: PMC3627816 DOI: 10.4103/2152-7806.104403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 11/06/2012] [Indexed: 11/26/2022] Open
Abstract
Introducción: Exponer la técnica utilizada y los resultados obtenidos en los primeros 52 pacientes portadores de tumores hipofisarios tratados por la vía endoscópica transnasal en el Hospital Italiano de Buenos Aires Métodos: Se llevó a cabo un análisis retrospectivo de 52 cirugías endoscópicas transnasales utilizadas en el tratamiento de tumores hipofisários. Las mismas fueron realizadas en el Hospital Italiano de Buenos Aires durante el período junio del 2011 a junio del 2012. Se analizaron las características demográficas de los pacientes, la patología de base y la morbimortalidad asociada a la cirugía. Resultados: La edad media de los pacientes fue de 41,52 años con un rango de 18-79. La distribución fue similar entre hombres y mujeres. Las patologías más frecuentes fueron: adenomas no funcionantes (40.4%), tumores productores de GH/Acromegalia (25%) y tumores productores de ACTH/Enfermedad de Cushing (23.1%). Aproximadamente el 70 % correspondieron a macroadenomas. Sólo un paciente presentó complicaciones. No se registro ningún óbito. Conclusión: Si bien podremos objetivar fehacientemente resultados más concluyentes en futuros trabajos, podemos decir a priori que, en la endoscopía el detalle anatómico es claramente superior al microscópico y que la posibilidad de la introducción del endoscopio en la silla turca permite la visualización directa de remanentes tumorales, de sitios de fístula y como así también de la glándula normal, ventajas que potencialmente podrían permitir obtener mejores resultados quirúrgicos, en términos de control de la enfermedad y tasa de complicaciones.
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Affiliation(s)
- Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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