scholarly journals MON-439 Evaluation of Surgical Resection Goal and Its Relationship to the Extent of Resection and Patient Outcomes in 221 Patients following Transsphenoidal Surgery for Nonfunctioning Pituitary Adenomas: Data from the TRANSSPHER Study

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Andrew Little ◽  
Kevin Yuen ◽  
Michael Chicoine ◽  
Daniel Kelly ◽  
Paul Gardner ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Patient Outcomes ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Extent Of Resection ◽  
Nonfunctioning Pituitary Adenomas

Results of a prospective multicenter controlled study comparing surgical outcomes of microscopic versus fully endoscopic transsphenoidal surgery for nonfunctioning pituitary adenomas: the Transsphenoidal Extent of Resection (TRANSSPHER) Study

2020 ◽  
Vol 132 (4) ◽  
pp. 1043-1053 ◽  
Author(s):  
Andrew S. Little ◽  
Daniel F. Kelly ◽  
William L. White ◽  
Paul A. Gardner ◽  
Juan C. Fernandez-Miranda ◽  
...  
Keyword(s):  
Endoscopic Surgery ◽  
Surgical Outcomes ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Endoscopic Technique ◽  
Controlled Study ◽  
Nonfunctioning Pituitary Adenomas ◽  
Microscopic Surgery

OBJECTIVEMany surgeons have adopted fully endoscopic over microscopic transsphenoidal surgery for nonfunctioning pituitary tumors, although no high-quality evidence demonstrates superior patient outcomes with endoscopic surgery. The goal of this analysis was to compare these techniques in a prospective multicenter controlled study.METHODSExtent of tumor resection was compared after endoscopic or microscopic transsphenoidal surgery in adults with nonfunctioning adenomas. The primary end point was gross-total tumor resection determined by postoperative MRI. Secondary end points included volumetric extent of tumor resection, pituitary hormone outcomes, and standard quality measures.RESULTSSeven pituitary centers and 15 surgeons participated in the study. Of the 530 patients screened, 260 were enrolled (82 who underwent microscopic procedures, 177 who underwent endoscopic procedures, and 1 who cancelled surgery) between February 2015 and June 2017. Surgeons who used the microscopic technique were more experienced than the surgeons who used the endoscopic technique in terms of years in practice and number of transsphenoidal surgeries performed (p < 0.001). Gross-total resection was achieved in 80.0% (60/75) of microscopic surgery patients and 83.7% (139/166) of endoscopic surgery patients (p = 0.47, OR 0.8, 95% CI 0.4–1.6). Volumetric extent of resection, length of stay, surgery-related deaths, and unplanned readmission rates were similar between groups (p > 0.2). New hormone deficiency was present at 6 months in 28.4% (19/67) of the microscopic surgery patients and 9.7% (14/145) of the endoscopic surgery patients (p < 0.001, OR 3.7, 95% CI 1.7–7.7). Microscopic surgery cases were significantly shorter in duration than endoscopic surgery cases (p < 0.001).CONCLUSIONSExperienced surgeons who performed microscopic surgery and less experienced surgeons who performed endoscopic surgery achieved similar extents of tumor resection and quality outcomes in patients with nonfunctioning pituitary adenomas. The endoscopic technique may be associated with lower rates of postoperative pituitary gland dysfunction. This study generally supports the transition to endoscopic pituitary surgery when the procedure is performed by proficient surgeons, although both techniques yield overall acceptable surgical outcomes.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: prospective cohort trial; evidence: class III.Clinical trial registration no.: NCT02357498 (clinicaltrials.gov)

Evaluation of Surgical Resection Goal and Its Relationship to Extent of Resection and Patient Outcomes in a Multicenter Prospective Study of Patients With Surgically Treated, Nonfunctioning Pituitary Adenomas: A Case Series

2019 ◽  
Vol 18 (1) ◽  
pp. 26-33
Author(s):  
Andrew S Little ◽  
Michael R Chicoine ◽  
Daniel F Kelly ◽  
Christina E Sarris ◽  
Michael A Mooney ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Predictive Value ◽  
Pituitary Adenomas ◽  
Tumor Resection ◽  
Case Series ◽  
Residual Tumor ◽  
Pituitary Surgery ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Nonfunctioning Pituitary Adenomas

Abstract BACKGROUND The influence of the surgeon's preoperative goal regarding the extent of tumor resection on patient outcomes has not been carefully studied among patients with nonfunctioning pituitary adenomas. OBJECTIVE To analyze the relationship between surgical tumor removal goal and patient outcomes in a prospective multicenter study. METHODS Centrally adjudicated extent of tumor resection (gross total resection [GTR] and subtotal resection [STR]) data were analyzed using standard univariate and multivariable analyses. RESULTS GTR was accomplished in 148 of 171 (86.5%) patients with planned GTR and 32 of 50 (64.0%) patients with planned STR (P = .001). Sensitivity, specificity, positive predictive value, and negative predictive value of GTR goal were 82.2, 43.9, 86.5, and 36.0%, respectively. Knosp grade 0-2, first surgery, and being an experienced surgeon were associated with surgeons choosing GTR as the goal (P &lt; .01). There was no association between surgical goal and presence of pituitary deficiency at 6 mo (P = .31). Tumor Knosp grade (P = .004) and size (P = .001) were stronger predictors of GTR than was surgical goal (P = .014). The most common site of residual tumor was the cavernous sinus (29 of 41 patients; 70.1%). CONCLUSION This is the first pituitary surgery study to examine surgical goal regarding extent of tumor resection and associated patient outcomes. Surgical goal is a poor predictor of actual tumor resection. A more aggressive surgical goal does not correlate with pituitary gland dysfunction. A better understanding of the ability of surgeons to meet their expectations and of the factors associated with surgical result should improve prognostication and preoperative counseling.

Extended endoscopic endonasal approach for selected pituitary adenomas: early experience

2011 ◽  
Vol 114 (2) ◽  
pp. 345-353 ◽  
Author(s):  
Salvatore Di Maio ◽  
Luigi M. Cavallo ◽  
Felice Esposito ◽  
Vita Stagno ◽  
Olga Valeria Corriero ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Extent Of Resection ◽  
Transsphenoidal Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Csf Leakage ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Extended Endoscopic Approach

Object Whereas most pituitary adenomas are removable via the transsphenoidal approach, certain cases, such as dumbbell-shaped or suprasellar adenomas and recurrent and/or fibrous tumors, remain difficult to treat. The authors present their experience with the extended endoscopic endonasal approach to the suprasellar area in managing this subset of tumors, which are classically treated through a transcranial route. Methods From June 1997 to December 2008, 615 patients underwent endoscopic endonasal transsphenoidal surgery for pituitary adenomas in the Department of Neurosurgery of the Università degli Studi di Napoli Federico II. Of this group, 20 patients with pituitary adenomas needed an extended endoscopic endonasal transtuberculum/transplanum approach for tumor removal. Two surgical corridors were used during the transsphenoidal approach: 1) the conventional endosellar extraarachnoidal corridor and 2) a suprasellar transarachnoidal corridor. Results The extent of resection was gross total in 12 (60%) of the 20 patients, near total in 4 (20%), subtotal in 3 (15%), and partial in 1 (5%). Postoperative CSF leakage occurred in 1 patient. One patient experienced worsening of temporal hemianopsia. Conclusions The authors' initial results with the extended endoscopic approach to the suprasellar area for selected pituitary adenomas are promising and may justify a widening of the current classical indications for transsphenoidal surgery.

scholarly journals An audit of transsphenoidal surgery on nonfunctioning pituitary adenomas

2015 ◽  
Author(s):  
Dolores Moure ◽  
Javier Santamaria ◽  
Ihintza Larranaga ◽  
Pedro Gonzalez ◽  
Sara Valle ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Nonfunctioning Pituitary Adenomas

Endocrine Outcomes after Endoscopic Transsphenoidal Surgery for Nonfunctioning Pituitary Adenomas

2021 ◽  
Author(s):  
Jenie H. Hwang ◽  
Diane J. Aum ◽  
Michael R. Chicoine ◽  
Ralph G. Dacey ◽  
Joshua W. Osbun ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Endoscopic Transsphenoidal Surgery ◽  
Nonfunctioning Pituitary Adenomas

Risks and Benefits of Endoscopic Transsphenoidal Surgery for Nonfunctioning Pituitary Adenomas in Patients of the Ninth Decade

2017 ◽  
Vol 106 ◽  
pp. 315-321 ◽  
Author(s):  
Rares Chinezu ◽  
Franklin Fomekong ◽  
Héllène Lasolle ◽  
Jacqueline Trouillas ◽  
Alexandre Vasiljevic ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Endoscopic Transsphenoidal Surgery ◽  
Nonfunctioning Pituitary Adenomas ◽  
Risks And Benefits

Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas: institutional experience and predictors of extent of resection

2014 ◽  
Vol 121 (1) ◽  
pp. 75-83 ◽  
Author(s):  
Kyle Juraschka ◽  
Osaama H. Khan ◽  
Bruno L. Godoy ◽  
Eric Monsalves ◽  
Alexandra Kilian ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Sphenoid Sinus ◽  
Tumor Volume ◽  
Extent Of Resection ◽  
Tumor Diameter ◽  
Endoscopic Endonasal ◽  
Posterior Extension ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Giant Pituitary Adenomas

Object While the use of endoscopic approaches has become increasingly accepted in the resection of pituitary adenomas, limited evidence exists regarding the success of this technique for patients with large and giant pituitary adenomas. This study reviews the outcomes of a large cohort of patients with large and giant pituitary adenomas who underwent endoscopic endonasal transsphenoidal surgery at the authors' institution and focuses on identifying factors that can predict extent of resection and hence aid in developing guidelines and indications for the use of endoscopic endonasal transsphenoidal surgery versus open craniotomy approaches to large and giant pituitary adenomas. Methods The authors reviewed 487 patients who underwent endoscopic endonasal transsphenoidal resection of sellar masses. From this group, 73 consecutive patients with large and giant pituitary adenomas (defined as maximum diameter ≥ 3 cm and tumor volume ≥ 10 cm3) who underwent endoscopic endonasal transsphenoidal surgery between January 1, 2006, and June 6, 2012, were included in the study. Clinical presentation, radiological studies, laboratory investigations, tumor pathology data, clinical outcomes, extent of resection measured by volumetric analysis, and complications were analyzed. Results The mean preoperative tumor diameter in this series was 4.1 cm and the volume was 18 cm3. The average resection rate was 82.9%, corresponding with a mean residual volume of 3 cm3. Gross-total resection was achieved in 16 patients (24%), near-total in 11 (17%), subtotal in 24 (36%), and partial in 15 (23%). Seventy-three percent of patients experienced improvement in visual acuity, while 24% were unchanged. Visual fields were improved in 61.8% and unchanged in 5.5%. Overall, 27 patients (37%) experienced a total of 32 complications. The most common complications were sinusitis (14%) and CSF leak (10%). Six patients underwent subsequent radiation therapy because of aggressive tumor histopathology. No deaths occurred in this cohort of patients. Statistically significant predictors of extent of resection included highest Knosp grade (p = 0.001), preoperative tumor volume (p = 0.025), preoperative maximum tumor diameter (p = 0.002), hemorrhagic component (p = 0.027), posterior extension (p = 0.001), and sphenoid sinus invasion (p = 0.005). Conclusions Endoscopic endonasal transsphenoidal surgery is an effective treatment method for patients with large and giant pituitary adenomas, which results in high (> 80%) rates of resection and improvement in visual function. It is not associated with high rates of major complications and is safe when performed by experienced surgeons. The preoperative Knosp grade, tumor volume, tumor diameter, hemorrhagic components on MRI, posterior extension, and sphenoid sinus invasion may allow a prediction of extent of resection and in these patients a staged operation may be required to maximize extent of resection.

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