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  • Endoscopic Endonasal Transsphenoidal Surgery for Functional Pituitary Adenomas

    Final Number:

    Christoph Hofstetter MD PhD; Benjamin Shin BS; Lynn Mubita MD; Clark Huang; Vijay K. Anand MD, FACS; John A. Boockvar MD; Theodore H. Schwartz MD, FACS

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: To analyze preoperative predictors of endocrinological cure following endonasal endoscopic resection of therapy-resistant prolactin (PRL)-, growth hormone (GH)- and adrenocorticotropin (ACTH)-secreting pituitary adenomas and establish benchmarks for cure using the most recent consensus criteria.

    Methods: We reviewed a prospective database of 86 consecutive functional pituitary adenomas that were resected by a purely endoscopic endonasal transsphenoidal technique. Extent of resection was evaluated on postoperative contrast-enhanced MRI. Endocrinological remission was defined according to the most recent consensus criteria.

    Results: The majority of functional adenomas (62.8%) were classified as macroadenomas (>1 cm in maximum diameter) and 24.4% of them had invaded the cavernous sinus at the time of surgery. A gross total resection was achieved in 75.6% of all patients. The rate of endocrinological remission differed between various types of functional adenomas. Cure rates were 92.3% (micro) and 57.1% (macro) for prolactinomas, 75% (micro) and 40% (macro) for GH-secreting tumors and 54.5% (micro) and 71.4% (macro) for ACTH-secreting tumors. Lower rates of cure occurred in GH-secreting macroadenomas due to a high rate of cavernous sinus invasion and in ACTH-secreting adenomas due to a high rate of non-visible lesions on pre-operative MRI. Whereas univariate analysis showed that macroadenoma, suprasellar, or cavernous extension and extent of resection correlated with cure, on multivariate analysis, only extent of resection predicted cure. One patient developed postoperative meningitis that was complicated by hydrocephalus requiring a ventriculoperitoneal shunt. Two patients developed postoperative panhypopituitarism and two patients suffered from CSF leaks which were treated with lumbar CSF diversion.

    Conclusions: This paper reports benchmarks for endocrinologic cure as well as complications in a large series of purely endoscopic pituitary surgeries using the most recent consensus criteria. The advantages of the extended endonasal approaches are most profound in tumors with suprasellar extension and cavernous sinus invasion.

    Patient Care: We attempt to minimize morbidity by minimizing surgical access as well as application of a multimodal treatment regiment for functional pituitary andenomas

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the goals and endocrinological outcome of surgical resection of functional pituitary tumors


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