Microsurgical therapy of pituitary adenomas
- 222 Downloads
We report the efficacy and safety of transsphenoidal microsurgery in a large and homogeneous cohort of patients with pituitary adenomas (PAs) treated at a single Institute by a single neurosurgeon.
A total of 2145 consecutive patients undergoing first surgery for a PA were included: 795 (37.1%) had a nonfunctioning pituitary adenoma (NFPA), 595 (27.7%) acromegaly, 496 (23.1%) Cushing’s disease, 208 (9.7%) a PRL-secreting adenoma, and 51 patients (2.4%) a TSH-secreting adenoma. Remission was achieved when strict hormonal and radiological criteria were met.
Early surgical remission was achieved in 66% of acromegalic patients, 79.6% of patients with Cushing’s disease, 64.4% of prolactinomas, 74.5% of patients with a TSH-secreting adenoma, and 66.9% of NFPAs. The mean (±SE) follow-up was 60.1 ± 1.3 months. The recurrence-free survival at 10 years was 78.2% in acromegalic patients, 68.1% in prolactinomas, 74.3% in Cushing’s disease, 70.3% in TSH-secreting adenomas, and 75.3% in NFPAs. Preoperative hypoadrenalism recovered in 35.3%, hypogonadism in 43.3% and hypothyroidism in 37.4% of patients with impaired function before surgery. The mortality rate was 0.2% and major morbidity 2.1%. New onset hypoadrenalism occurred after surgery in 2.5% of patients at risk, hypogonadism in 4.1%, and hypothyroidism in 1.8%. Permanent diabetes insipidus (DI) occurred in 0.9% of patients.
In experienced hands, transsphenoidal microsurgery for PAs achieves remission in most patients with a low complication rate. Pituitary function is preserved in most cases and can recover in more than one-third of patients with preoperative hypopituitarism.
KeywordsPituitary adenomas Transsphenoidal surgery Surgical results Surgical complications.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 12.R.M. Starke, D.M. Raper, S.C. Payne, M.L. Vance, E.H. Oldfield, J.A. Jane Jr., Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission. J. Clin. Endocrinol. Metabol. 98(8), 3190–3198 (2013). https://doi.org/10.1210/jc.2013-1036 CrossRefGoogle Scholar
- 13.P. McCulloch, D.G. Altman, W.B. Campbell, D.R. Flum, P. Glasziou, J.C. Marshall, J. Nicholl, C. Balliol, J.K. Aronson, J.S. Barkun, J.M. Blazeby, I.C. Boutron, W.B. Campbell, P.A. Clavien, J.A. Cook, P.L. Ergina, L.S. Feldman, D.R. Flum, G.J. Maddern, J. Nicholl, B.C. Reeves, C.M. Seiler, S.M. Strasberg, J.L. Meakins, D. Ashby, N. Black, J. Bunker, M. Burton, M. Campbell, K. Chalkidou, I. Chalmers, M. de Leval, J. Deeks, P.L. Ergina, A. Grant, M. Gray, R. Greenhalgh, M. Jenicek, S. Kehoe, R. Lilford, P. Littlejohns, Y. Loke, R. Madhock, K. McPherson, J. Meakins, P. Rothwell, B. Summerskill, D. Taggart, P. Tekkis, M. Thompson, T. Treasure, U. Trohler, J. Vandenbroucke, No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374(9695), 1105–1112 (2009). https://doi.org/10.1016/S0140-6736(09)61116-8 CrossRefPubMedGoogle Scholar
- 14.S.S. Shin, M.J. Tormenti, A. Paluzzi, W.E. Rothfus, Y.F. Chang, H. Zainah, J.C. Fernandez-Miranda, C.H. Snyderman, S.M. Challinor, P.A. Gardner, Endoscopic endonasal approach for growth hormone secreting pituitary adenomas: outcomes in 53 patients using 2010 consensus criteria for remission. Pituitary 16(4), 435–444 (2013). https://doi.org/10.1007/s11102-012-0440-6 CrossRefPubMedGoogle Scholar
- 22.C.A. Donofrio, M. Losa, M. Gemma, L. Giudice, L.R. Barzaghi, P. Mortini, Safety of transsphenoidal microsurgical approach in patients with an ACTH-secreting pituitary adenoma. Endocrine (2016). https://doi.org/10.1007/s12020-016-1214-0
- 23.A. Abosch, J.B. Tyrrell, K.R. Lamborn, L.T. Hannegan, C.B. Applebury, C.B. Wilson, Transsphenoidal microsurgery for growth hormone-secreting pituitary adenomas: initial outcome and long-term results. J. Clin. Endocrinol. Metabol. 83(10), 3411–3418 (1998). https://doi.org/10.1210/jcem.83.10.5111 CrossRefGoogle Scholar
- 26.A.R. Dehdashti, A. Ganna, K. Karabatsou, F. Gentili, Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery 62(5), 1006–1015 (2008). https://doi.org/10.1227/01.neu.0000325862.83961.12 CrossRefPubMedGoogle Scholar
- 27.J.A. Gondim, J.P. Almeida, L.A. Albuquerque, M. Schops, E. Gomes, T. Ferraz, W. Sobreira, M.T. Kretzmann, Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients. Pituitary 14(2), 174–183 (2011). https://doi.org/10.1007/s11102-010-0280-1 CrossRefPubMedGoogle Scholar
- 29.H. Halvorsen, J. Ramm-Pettersen, R. Josefsen, P. Ronning, S. Reinlie, T. Meling, J. Berg-Johnsen, J. Bollerslev, E. Helseth, Surgical complications after transsphenoidal microscopic and endoscopic surgery for pituitary adenoma: a consecutive series of 506 procedures. Acta Neurochir. 156(3), 441–449 (2014). https://doi.org/10.1007/s00701-013-1959-7 CrossRefPubMedGoogle Scholar
- 30.J.H. Jang, K.H. Kim, Y.M. Lee, J.S. Kim, Y.Z. Kim, Surgical results of pure endoscopic endonasal transsphenoidal surgery for 331 pituitary adenomas: a 15-year experience from a single institution. World Neurosurg. 96, 545–555 (2016). https://doi.org/10.1016/j.wneu.2016.09.051 CrossRefPubMedGoogle Scholar
- 31.E. Magro, T. Graillon, J. Lassave, F. Castinetti, S. Boissonneau, E. Tabouret, S. Fuentes, L. Velly, R. Gras, H. Dufour, Complications related to the endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary macroadenomas in 300 consecutive patients. World Neurosurg. 89, 442–453 (2016). https://doi.org/10.1016/j.wneu.2016.02.059 CrossRefPubMedGoogle Scholar
- 33.C.I. Eseonu, K. ReFaey, J. Rincon-Torroella, O. Garcia, G.S. Wand, R. Salvatori, A. Quinones-Hinojosa, Endoscopic versus microscopic transsphenoidal approach for pituitary adenomas: comparison of outcomes during the transition of methods of a single surgeon. World Neurosurg. 97, 317–325 (2017). https://doi.org/10.1016/j.wneu.2016.09.120 CrossRefPubMedGoogle Scholar
- 37.M. Losa, P. Mortini, R. Barzaghi, P. Ribotto, M.R. Terreni, S.B. Marzoli, S. Pieralli, M. Giovanelli, Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence. J. Neurosurg. 108(3), 525–532 (2008). https://doi.org/10.3171/JNS/2008/108/3/0525 CrossRefPubMedGoogle Scholar
- 38.S. Brochier, F. Galland, M. Kujas, F. Parker, S. Gaillard, C. Raftopoulos, J. Young, O. Alexopoulou, D. Maiter, P. Chanson, Factors predicting relapse of nonfunctioning pituitary macroadenomas after neurosurgery: a study of 142 patients. Eur. J. Endocrinol. 163(2), 193–200 (2010). https://doi.org/10.1530/EJE-10-0255 CrossRefPubMedGoogle Scholar
- 39.A. Steno, J. Bocko, B. Rychly, M. Chorvath, P. Celec, M. Fabian, V. Belan, J. Steno, Nonfunctioning pituitary adenomas: association of Ki-67 and HMGA-1 labeling indices with residual tumor growth. Acta Neurochir. 156(3), 451–461 (2014). https://doi.org/10.1007/s00701-014-1993-0.CrossRefPubMedGoogle Scholar
- 40.S. Chiloiro, A. Bianchi, F. Doglietto, C. de Waure, A. Giampietro, A. Fusco, D. Iacovazzo, L. Tartaglione, F. Di Nardo, F. Signorelli, L. Lauriola, C. Anile, G. Rindi, G. Maira, A. Pontecorvi, L. De Marinis, Radically resected pituitary adenomas: prognostic role of Ki 67 labeling index in a monocentric retrospective series and literature review. Pituitary 17(3), 267–276 (2014). https://doi.org/10.1007/s11102-013-0500-6 PubMedGoogle Scholar
- 42.M. Losa, G. Spatola, L. Albano, A. Gandolfi, A. Del Vecchio, A. Bolognesi, P. Mortini, Frequency, pattern, and outcome of recurrences after gamma knife radiosurgery for pituitary adenomas. Endocrine (2016). doi: https://doi.org/10.1007/s12020-016-1081-8
- 43.L.R. Barzaghi, M. Medone, M. Losa, S. Bianchi, M. Giovanelli, P. Mortini, Prognostic factors of visual field improvement after trans-sphenoidal approach for pituitary macroadenomas: review of the literature and analysis by quantitative method. Neurosurg. Rev. 35(3), 369–378 (2012). https://doi.org/10.1007/s10143-011-0365-y CrossRefPubMedGoogle Scholar
- 45.A. Jahangiri, J. Wagner, S.W. Han, M.T. Tran, L.M. Miller, M.W. Tom, L.R. Ostling, S. Kunwar, L. Blevins, M.K. Aghi, Rate and time course of improvement in endocrine function after more than 1000 pituitary operations. Neurosurgery 61(Suppl 1), 163–166 (2014). https://doi.org/10.1227/NEU.0000000000000405 CrossRefGoogle Scholar
- 48.D.J. Cote, H.H. Dasenbrock, I.S. Muskens, M.L. Broekman, H.A. Zaidi, I.F. Dunn, T.R. Smith, E.R. Laws Jr., Readmission and other adverse events after transsphenoidal surgery: prevalence, timing, and predictive factors. J. Am. Coll. Surg. (2017). https://doi.org/10.1016/j.jamcollsurg.2017.02.015
- 49.P. Mortini, R. Barzaghi, M. Losa, N. Boari, M. Giovanelli, Surgical treatment of giant pituitary adenomas: strategies and results in a series of 95 consecutive patients. Neurosurgery 60(6), 993–1002 (2007). https://doi.org/10.1227/01.NEU.0000255459.14764.BA CrossRefPubMedGoogle Scholar