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Pituitary

, Volume 22, Issue 5, pp 507–513 | Cite as

Peel-off resection of the pituitary gland for functional pituitary adenomas: pathological significance and impact on pituitary function

  • Yuichi NagataEmail author
  • Kazuhito Takeuchi
  • Taiki Yamamoto
  • Takayuki Ishikawa
  • Teppei Kawabata
  • Yoshie Shimoyama
  • Naoko Inoshita
  • Toshihiko Wakabayashi
Article
  • 49 Downloads

Abstract

Purpose

Functional pituitary adenomas (FPAs) lacking a well-defined pseudocapsule can invade the adjacent pituitary gland. In such situations, peel-off resection of the adjacent pituitary gland after selective adenomectomy might lead to complete tumor removal, resulting in optimal endocrinological outcomes. Here, we present the significance of peel-off resection of the pituitary gland in patients with FPA in whom complete extracapsular tumor removal cannot be achieved.

Methods

We performed a retrospective review of 21 patients with FPA who underwent transsphenoidal surgery (TSS). After selective adenomectomy, peel-off resection of the adjacent pituitary gland was performed in 13 patients because complete extracapsular resection could not be achieved, while peel-off resection was not performed in the remaining 8 patients because complete extracapsular resection was accomplished. The clinical outcomes of these groups were compared. The pituitary tissues obtained by peel-off resection were pathologically examined for tumor cells.

Results

Early postoperative biochemical remission was achieved in 20 patients (95.2%). Anterior pituitary functions were not aggravated postoperatively in any patient: however, transient diabetes insipidus (DI) occurred in 2 patients. There were no statistically significant differences in the clinical outcomes of the two groups. A pseudocapsule was pathologically detected in the adjacent anterior pituitary even in patients in whom no pseudocapsule was intraoperatively detected. Tumor cells were pathologically detected in 7 (58.3%) of 12 pituitary tissues examined.

Conclusions

Peel-off resection of the pituitary gland, which can remove a small tumor cell remnant in the adjacent pituitary, might maximize the effectiveness of TSS with minimal impact on postoperative pituitary function.

Keywords

Pituitary resection Transsphenoidal surgery Pseudocapsule Pituitary adenoma Acromegaly Cushing disease 

Notes

Funding

None

Compliance with ethical standards

Conflict of interests

The authors declare that they have no conflicts of interest.

Ethical approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional or national research committee and with either the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. For this type of study, formal consent was not required.

Informed consent

Informed consent was obtained from all individual participants who were included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of Pathology and Clinical LaboratoryNagoya University HospitalNagoyaJapan
  3. 3.Department of PathologyTokyo Metropolitan Geriatric Hospital and Institute of GerontologyTokyoJapan

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