Faculty Collaboration Database

Evaluation of Outcomes After Endoscopic Endonasal Surgery for Large and Giant Pituitary Macroadenoma: A Retrospective Review of 39 Consecutive Patients. World Neurosurg 2015 Oct;84(4):978-88

Date

06/16/2015

Pubmed ID

26074433

DOI

10.1016/j.wneu.2015.06.007

Scopus ID

2-s2.0-84943251227 (requires institutional sign-in at Scopus site)   79 Citations

Abstract

BACKGROUND: The endoscopic endonasal approach for pituitary neoplasms has shown similar efficacy compared with the microscopic approach. However, outcomes and complication rates with larger macroadenomas is not as well documented. This study addresses the efficacy and outcome of the fully endoscopic endonasal approach for large and giant pituitary adenomas.

METHODS: Endoscopic endonasal resection was performed in 39 patients with large (>3 cm) or giant (>4 cm) pituitary macroadenomas. Outcomes were assessed using formal visual examinations, endocrine status, and neurologic examinations. Statistical analyses of multiple variables were addressed for correlation to visual, endocrine, and neurologic outcomes.

RESULTS: Gross total resection of the pituitary macroadenoma was achieved in 22 of 39 (56.4%) patients based on postoperative magnetic resonance imaging. Higher Knosp grade was associated with near-total resection or subtotal resection (P = 0.0004). All patients had improved or stable visual symptoms. Time to diagnosis, preoperative visual deficit, and tumor size were not significant predictors of visual outcome. Of patients, 34 (87.1%) had a "good" endocrine outcome, whereas 5 did not. Among the 5 patients who did not have a good outcome, 1 had new hypopituitarism, and 4 required increased dosages of pharmacologic therapy. All patients with recurrent tumors had stable visual and good endocrine outcomes. Postoperative cerebrospinal fluid leak occurred in 4 patients; lumbar drainage resolved the leak in 3, and reoperation was performed in 1 patient. There were no new cranial nerve deficits, new neurologic deficits, or mortality.

CONCLUSIONS: Endoscopic endonasal resection of large and giant pituitary macroadenomas is safe and efficient. Postoperative complications, including cerebrospinal fluid leak, are low. Surgical efficacy of the fully endoscopic endonasal approach for large and giant macroadenomas makes the technique a preferable option in this subset of patients.

Author List

Chabot JD, Chakraborty S, Imbarrato G, Dehdashti AR

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Cranial Nerve Diseases
Endoscopy
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Nasal Cavity
Neurosurgical Procedures
Pituitary Function Tests
Pituitary Neoplasms
Postoperative Complications
Retrospective Studies
Surgical Flaps
Treatment Outcome
Vision, Ocular
Visual Acuity
Visual Fields
Young Adult