In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Long-term results of pure endonasal endoscopic transsphenoidal resection of nonfunctioning pituitary macroadenomas in patients with a minimum of 5 year follow up

    Final Number:
    1420

    Authors:
    Robert Dallapiazza MD PhD; Robert M. Starke MD MSc; Edward R. Laws, Jr. MD FACS FAANS; John Jane, Jr

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: To report the long-term outcomes after an endoscopic endonasal transsphenoidal resection of clinically nonfunctioning pituitary macroadenomas.

    Methods: This is a retrospective review of a prospectively collected database. All patients underwent a pure endoscopic transsphenoidal resection of a nonfunctioning pituitary macroadenoma. Patients were included if they had at least 5 years of clinical and imaging follow up. Patient records were reviewed for neurological and endocrinologic outcomes, recurrences, and additional surgical procedures.

    Results: Eighty patients met the study criteria. Visual deficits were present in 52% of patients. Seventy-one percent of patients had no residual on MRI at 1-year follow up. Patients with Knosp grade 0-2 tumors and tumor volumes <10 cm3 were significantly more likely to have received a gross total resection compared to patients with Knosp grade 3, 4 tumors or volumes >10 cm3. At long-term follow up, there were 7 (12%) recurrences in patients who had received grossly complete resections. In patients who had subtotal resections, five patients underwent secondary treatments within 12 mo of ETSS. Eighteen patients with subtotal resections were managed expectantly with annual neurological exam and MRI. Among these patients, 11 (61%) progressed radiographically and 3 (17%) had symptomatic progression. Knosp score, surgical and radiographic evidence of invasion, and preoperative visual deficits were predictive of recurrence in a univariate analysis. Overall, twenty five percent of the patients had stereotactic gamma knife radiosurgery, and 9% of patients had repeat transsphenoidal surgery for residual or recurrent tumors. Five percent of patients had major surgical complications.

    Conclusions: At long term follow up 12% of patients had recurrent tumors after gross total resection. Recurrent or residual tumors were treated with either repeat surgery or GKRS. Rates of complete resection, postoperative surgical and endocrinological complications, and additional surgical procedures are similar to previously published reports after microscopic transsphenoidal surgery.

    Patient Care: This study reports the long term outcomes, additional procedures, and complications of endoscopic surgery.

    Learning Objectives: 1.) The incidence of tumor recurrence after a grossly total resection is 12%. 2.) The rate of radiographic progression after subtotal resection is 61% without further treatments.

    References: 1. Altman D: Practical statistics for medical research. Chapman and Hall/CRC Boca Raton, FL, 1999 2. Andersen M, Bjerre P, Schroder HD, et al: In vivo secretory potential and the effect of combination therapy with octreotide and cabergoline in patients with clinically non-functioning pituitary adenomas. Clin Endocrinol (Oxf) 54:23-30, 2001 3. Cappabianca P, Cavallo LM, Colao A, et al: Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 97:293-298, 2002 4. Cappabianca P, Cavallo LM, Colao A, et al: Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg 45:193-200, 2002 5. Charalampaki P, Reisch R, Ayad A, et al: Endoscopic endonasal pituitary surgery: surgical and outcome analysis of 50 cases. J Clin Neurosci 14:410-415, 2007 6. Comtois R, Beauregard H, Somma M, et al: The clinical and endocrine outcome to trans-sphenoidal microsurgery of nonsecreting pituitary adenomas. Cancer 68:860-866, 1991 7. Crowley RW, Dumont AS, Jane JA, Jr.: Bilateral intracavernous carotid artery pseudoaneurysms as a result of sellar reconstruction during the transsphenoidal resection of a pituitary macroadenoma: case report. Minim Invasive Neurosurg 52:44-48, 2009 8. Dehdashti AR, Ganna A, Karabatsou K, et al: Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery 62:1006-1015; discussion 1015-1007, 2008 9. Ebersold MJ, Laws ER, Jr., Scheithauer BW, et al: Pituitary apoplexy treated by transsphenoidal surgery. A clinicopathological and immunocytochemical study. J Neurosurg 58:315-320, 1983 10. Ferrante E, Ferraroni M, Castrignano T, et al: Non-functioning pituitary adenoma database: a useful resource to improve the clinical management of pituitary tumors. Eur J Endocrinol 155:823-829, 2006 11. Gasperi M, Petrini L, Pilosu R, et al: Octreotide treatment does not affect the size of most non-functioning pituitary adenomas. J Endocrinol Invest 16:541-543, 1993 12. Gondim JA, Almeida JP, Albuquerque LA, et al: Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients. Pituitary 14:174-183 13. Greenman Y, Ouaknine G, Veshchev I, et al: Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth. Clin Endocrinol (Oxf) 58:763-769, 2003 14. Greenman Y, Stern N: How should a nonfunctioning pituitary macroadenoma be monitored after debulking surgery? Clin Endocrinol (Oxf) 70:829-832, 2009 15. Honegger J, Ernemann U, Psaras T, et al: Objective criteria for successful transsphenoidal removal of suprasellar nonfunctioning pituitary adenomas. A prospective study. Acta Neurochir (Wien) 149:21-29; discussion 29, 2007 16. Jho HD, Carrau RL: Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87:44-51, 1997 17. Katznelson L, Oppenheim DS, Coughlin JF, et al: Chronic somatostatin analog administration in patients with alpha-subunit-secreting pituitary tumors. J Clin Endocrinol Metab 75:1318-1325, 1992 18. Kelly DF, Oskouian RJ, Fineman I: Collagen sponge repair of small cerebrospinal fluid leaks obviates tissue grafts and cerebrospinal fluid diversion after pituitary surgery. Neurosurgery 49:885-889; discussion 889-890, 2001 19. Knosp E SE, Kitz K, Matula C.: Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery. 33:610-618, 1993 20. Koc K, Anik I, Ozdamar D, et al: The learning curve in endoscopic pituitary surgery and our experience. Neurosurg Rev 29:298-305; discussion 305, 2006 21. Losa M, Mortini P, Barzaghi R, et al: Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence. J Neurosurg 108:525-532, 2008 22. Meij BP, Lopes MB, Ellegala DB, et al: The long-term significance of microscopic dural invasion in 354 patients with pituitary adenomas treated with transsphenoidal surgery. J Neurosurg 96:195-208, 2002 23. Mingione V, Yen CP, Vance ML, et al: Gamma surgery in the treatment of nonsecretory pituitary macroadenoma. J Neurosurg 104:876-883, 2006 24. Nakao N, Itakura T: Surgical outcome of the endoscopic endonasal approach for non-functioning giant pituitary adenoma. J Clin Neurosci 18:71-75 25. O'Sullivan EP, Woods C, Glynn N, et al: The natural history of surgically treated but radiotherapy-naive nonfunctioning pituitary adenomas. Clin Endocrinol (Oxf) 71:709-714, 2009 26. Park P, Chandler WF, Barkan AL, et al: The role of radiation therapy after surgical resection of nonfunctional pituitary macroadenomas. Neurosurgery 55:100-106; discussion 106-107, 2004 27. Picozzi P, Losa M, Mortini P, et al: Radiosurgery and the prevention of regrowth of incompletely removed nonfunctioning pituitary adenomas. J Neurosurg 102 Suppl:71-74, 2005 28. Rudnik A, Zawadzki T, Galuszka-Ignasiak B, et al: Endoscopic transsphenoidal treatment in recurrent and residual pituitary adenomas--first experience. Minim Invasive Neurosurg 49:10-14, 2006 29. Sheehan JP, Kondziolka D, Flickinger J, et al: Radiosurgery for nonfunctioning pituitary adenoma. Neurosurg Focus 14:e9, 2003 30. Sheehan JP, Kondziolka D, Flickinger J, et al: Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma. J Neurosurg 97:408-414, 2002 31. Sheehan JP, Starke RM, Mathieu D, et al: Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study. J Neurosurg 119:446-456 32. Shiley SG LF, Delashaw JB, Barnwell SL, Andersen PE, Hwang PH, Wax MK.: Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery. Laryngoscope 113:1283-1288, 2003 33. Starke RM, Raper DM, Payne SC, et al: Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission. J Clin Endocrinol Metab 98:3190-3198 34. Starke RM, Williams BJ, Jane JA, Jr., et al: Gamma Knife surgery for patients with nonfunctioning pituitary macroadenomas: predictors of tumor control, neurological deficits, and hypopituitarism. J Neurosurg 117:129-135 35. Turner HE, Stratton IM, Byrne JV, et al: Audit of selected patients with nonfunctioning pituitary adenomas treated without irradiation - a follow-up study. Clin Endocrinol (Oxf) 51:281-284, 1999 36. Uren B, Vrodos N, Wormald PJ: Fully endoscopic transsphenoidal resection of pituitary tumors: technique and results. Am J Rhinol 21:510-514, 2007 37. Woollons AC, Hunn MK, Rajapakse YR, et al: Non-functioning pituitary adenomas: indications for postoperative radiotherapy. Clin Endocrinol (Oxf) 53:713-717, 2000 38. Yano S, Kawano T, Kudo M, et al: Endoscopic endonasal transsphenoidal approach through the bilateral nostrils for pituitary adenomas. Neurol Med Chir (Tokyo) 49:1-7, 2009 39. Zhang X, Fei Z, Zhang J, et al: Management of nonfunctioning pituitary adenomas with suprasellar extensions by transsphenoidal microsurgery. Surg Neurol 52:380-385, 1999

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy