Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas

Christoph P. Hofstetter, Benjamin J. Shin, Lynn Mubita, Clark Huang, Vijay K. Anand, John A. Boockvar, Theodore H. Schwartz

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65 Citations (Scopus)

Abstract

Object: The purpose of this study was to analyze preoperative predictors of endocrinological remission following endonasal endoscopic resection of therapy-resistant prolactingrowth hormone (GH)-, and adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas and to establish benchmarks for cure by using the most recent consensus criteria. Methods: The authors 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 MR imaging. 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 20.9% of lesions had invaded the cavernous sinus (CS) 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% (microadenomas) and 57.1% (macroadenomas) for prolactinomas, 75% (microadenomas) and 40% (macroadenomas) for GH-secreting tumors, and 54.5% (microadenomas) and 71.4% (macroadenomas) for ACTH-secreting tumors. Lower rates of cure occurred in GH-secreting macroadenomas due to a high rate of CS invasion, and in ACTH-secreting adenomas due to a high rate of lesions that were not visible on preoperative MR imaging. Whereas univariate analysis showed that macroadenoma, suprasellar, cavernous extension, or extent of resection correlated with cure, on multivariate analysis, only extent of resection and suprasellar extension predicted cure. One patient developed postoperative meningitis that was complicated by hydrocephalus requiring a ventriculoperitoneal shunt. Two patients developed postoperative panhypopituitarism, and 2 patients suffered from CSF leaks, which were treated with lumbar CSF diversion. Conclusions: This paper reports benchmarks for endocrinological cure as well as complications in a large series of purely endoscopic pituitary surgeries by using the most recent consensus criteria. The advantages of extended endonasal approaches are most profound in tumors with suprasellar extension and CS invasion.

Original languageEnglish (US)
Article numberE10
JournalNeurosurgical focus
Volume30
Issue number4
DOIs
StatePublished - Apr 1 2011

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Pituitary Neoplasms
Cavernous Sinus
Adenoma
Adrenocorticotropic Hormone
Benchmarking
Prolactinoma
Ventriculoperitoneal Shunt
Neoplasms
Hydrocephalus
Meningitis
Multivariate Analysis
Databases
Hormones
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Hofstetter, C. P., Shin, B. J., Mubita, L., Huang, C., Anand, V. K., Boockvar, J. A., & Schwartz, T. H. (2011). Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas. Neurosurgical focus, 30(4), [E10]. https://doi.org/10.3171/2011.1.FOCUS10317
Hofstetter, Christoph P. ; Shin, Benjamin J. ; Mubita, Lynn ; Huang, Clark ; Anand, Vijay K. ; Boockvar, John A. ; Schwartz, Theodore H. / Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas. In: Neurosurgical focus. 2011 ; Vol. 30, No. 4.
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abstract = "Object: The purpose of this study was to analyze preoperative predictors of endocrinological remission following endonasal endoscopic resection of therapy-resistant prolactingrowth hormone (GH)-, and adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas and to establish benchmarks for cure by using the most recent consensus criteria. Methods: The authors 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 MR imaging. 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 20.9{\%} of lesions had invaded the cavernous sinus (CS) 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{\%} (microadenomas) and 57.1{\%} (macroadenomas) for prolactinomas, 75{\%} (microadenomas) and 40{\%} (macroadenomas) for GH-secreting tumors, and 54.5{\%} (microadenomas) and 71.4{\%} (macroadenomas) for ACTH-secreting tumors. Lower rates of cure occurred in GH-secreting macroadenomas due to a high rate of CS invasion, and in ACTH-secreting adenomas due to a high rate of lesions that were not visible on preoperative MR imaging. Whereas univariate analysis showed that macroadenoma, suprasellar, cavernous extension, or extent of resection correlated with cure, on multivariate analysis, only extent of resection and suprasellar extension predicted cure. One patient developed postoperative meningitis that was complicated by hydrocephalus requiring a ventriculoperitoneal shunt. Two patients developed postoperative panhypopituitarism, and 2 patients suffered from CSF leaks, which were treated with lumbar CSF diversion. Conclusions: This paper reports benchmarks for endocrinological cure as well as complications in a large series of purely endoscopic pituitary surgeries by using the most recent consensus criteria. The advantages of extended endonasal approaches are most profound in tumors with suprasellar extension and CS invasion.",
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Hofstetter, CP, Shin, BJ, Mubita, L, Huang, C, Anand, VK, Boockvar, JA & Schwartz, TH 2011, 'Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas', Neurosurgical focus, vol. 30, no. 4, E10. https://doi.org/10.3171/2011.1.FOCUS10317

Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas. / Hofstetter, Christoph P.; Shin, Benjamin J.; Mubita, Lynn; Huang, Clark; Anand, Vijay K.; Boockvar, John A.; Schwartz, Theodore H.

In: Neurosurgical focus, Vol. 30, No. 4, E10, 01.04.2011.

Research output: Contribution to journalArticle

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T1 - Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas

AU - Hofstetter, Christoph P.

AU - Shin, Benjamin J.

AU - Mubita, Lynn

AU - Huang, Clark

AU - Anand, Vijay K.

AU - Boockvar, John A.

AU - Schwartz, Theodore H.

PY - 2011/4/1

Y1 - 2011/4/1

N2 - Object: The purpose of this study was to analyze preoperative predictors of endocrinological remission following endonasal endoscopic resection of therapy-resistant prolactingrowth hormone (GH)-, and adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas and to establish benchmarks for cure by using the most recent consensus criteria. Methods: The authors 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 MR imaging. 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 20.9% of lesions had invaded the cavernous sinus (CS) 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% (microadenomas) and 57.1% (macroadenomas) for prolactinomas, 75% (microadenomas) and 40% (macroadenomas) for GH-secreting tumors, and 54.5% (microadenomas) and 71.4% (macroadenomas) for ACTH-secreting tumors. Lower rates of cure occurred in GH-secreting macroadenomas due to a high rate of CS invasion, and in ACTH-secreting adenomas due to a high rate of lesions that were not visible on preoperative MR imaging. Whereas univariate analysis showed that macroadenoma, suprasellar, cavernous extension, or extent of resection correlated with cure, on multivariate analysis, only extent of resection and suprasellar extension predicted cure. One patient developed postoperative meningitis that was complicated by hydrocephalus requiring a ventriculoperitoneal shunt. Two patients developed postoperative panhypopituitarism, and 2 patients suffered from CSF leaks, which were treated with lumbar CSF diversion. Conclusions: This paper reports benchmarks for endocrinological cure as well as complications in a large series of purely endoscopic pituitary surgeries by using the most recent consensus criteria. The advantages of extended endonasal approaches are most profound in tumors with suprasellar extension and CS invasion.

AB - Object: The purpose of this study was to analyze preoperative predictors of endocrinological remission following endonasal endoscopic resection of therapy-resistant prolactingrowth hormone (GH)-, and adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas and to establish benchmarks for cure by using the most recent consensus criteria. Methods: The authors 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 MR imaging. 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 20.9% of lesions had invaded the cavernous sinus (CS) 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% (microadenomas) and 57.1% (macroadenomas) for prolactinomas, 75% (microadenomas) and 40% (macroadenomas) for GH-secreting tumors, and 54.5% (microadenomas) and 71.4% (macroadenomas) for ACTH-secreting tumors. Lower rates of cure occurred in GH-secreting macroadenomas due to a high rate of CS invasion, and in ACTH-secreting adenomas due to a high rate of lesions that were not visible on preoperative MR imaging. Whereas univariate analysis showed that macroadenoma, suprasellar, cavernous extension, or extent of resection correlated with cure, on multivariate analysis, only extent of resection and suprasellar extension predicted cure. One patient developed postoperative meningitis that was complicated by hydrocephalus requiring a ventriculoperitoneal shunt. Two patients developed postoperative panhypopituitarism, and 2 patients suffered from CSF leaks, which were treated with lumbar CSF diversion. Conclusions: This paper reports benchmarks for endocrinological cure as well as complications in a large series of purely endoscopic pituitary surgeries by using the most recent consensus criteria. The advantages of extended endonasal approaches are most profound in tumors with suprasellar extension and CS invasion.

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