Skip to main content

Endoscopic endonasal transsphenoidal surgery: predictors for disease control in a consecutive series of pituitary adenomas

En

Abstract

Background

Endoscopic endonasal transsphenoidal surgery for pituitary lesions has been predestined and evolved since its incipient description. However, tumour size and extrasellar extensions of pituitary adenomas remain a challenge for disease control (DC) after surgery. This study was conducted to evaluate the predictors that determine the early outcome in a consecutive series of pituitary adenomas operated using an endoscopic transsphenoidal approach.

Materials and methods

Sixty-five consecutive pituitary adenomas presenting over a 36-month period subjected to excision through an entirely endoscopic transsphenoidal approach were reviewed. DC, based on the extent of tumour resection and endocrinological remission, was evaluated according to the recent radiological and hormonal consensus criteria.

Results

Of 65 pituitary adenomas operated, 24 were endocrinally nonfunctioning and 41 were functioning adenomas. The follow-up duration ranged from 3 to 33 months. The overall DC was 67.7% as measured using total tumour resection and endocrinal cure. Cavernous sinus invasion, suprasellar extension and revision surgery negatively influenced DC of pituitary adenomas. Postoperative complications related to surgical resection of adenomas were seen in 12 cases (18.5%) − mainly, cerebrospinal fluid leakage, anterior pituitary insufficiency, and diabetes insipidus.

Conclusion

This study reports standards for DC in a short follow-up series of purely endoscopic pituitary surgeries and identifies pituitary lesions associated with preoperative predictors that can influence postoperative outcome. These results authenticate the efficacy and safety of endoscopic endonasal transsphenoidal surgery in the treatment of pituitary adenomas, providing favourable DC for both functioning and nonfunctioning pituitary adenomas.

References

  1. 1

    Ammirati M, Wei L, Ciric I. Short-term outcome of endoscopic versus microscopic pituitary adenoma surgery: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2013; 84: 843–849.

    Article  Google Scholar 

  2. 2

    Prevedello DM, Kassam AB, Gardner PA, Carrau RL, Snyderman CH. Expanded endoscopic endonasal approaches to the skull base. Cranial, craniofacial and skull base surgery. Springer; 2010: 239–251.

  3. 3

    Doglietto F, Prevedello DM, Jane JA Jr, Han J, Laws ER Jr. Brief history of endoscopic transsphenoidal surgery − from Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery. Neurosurg Focus 2005; 19: E3.

    Article  Google Scholar 

  4. 4

    Gandhi CD, Christiano LD, Eloy JA, Prestigiacomo CJ, Post KD. The historical evolution of transsphenoidal surgery: facilitation by technological advances. Neurosurg Focus 2009; 27: E8.

    Article  Google Scholar 

  5. 5

    Jankowski R, Auque J, Simon C, Marchal JC, Hepner H, Wayoff M. How i do it: head and neck and plastic surgery: endoscopic pituitary tumor surgery. Laryngoscope 1992; 102: 198–202.

    CAS  Article  Google Scholar 

  6. 6

    Sethi DS, Stanley RE, Pillay PK. Endoscopic anatomy of the sphenoid sinus and sella turcica. J Laryngol Otol 1995; 109: 951–955.

    CAS  Article  Google Scholar 

  7. 7

    Jho HD, Carrau RL. Endoscopy assisted transsphenoidal surgery for pituitary adenoma. Technical note. Acta Neurochir (Wien) 1996; 138: 1416–1425.

    CAS  Article  Google Scholar 

  8. 8

    Cappabianca P, Alfieri A, de Divitiis E. Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS). Minim Invasive Neurosurg 1998; 41: 66–73.

    CAS  Article  Google Scholar 

  9. 9

    Cavallo LM, Messina A, Cappabianca P, Esposito F, de Divitiis E, Gardner P, Tschabitscher M. Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus 2005; 19: E2.

    PubMed  Google Scholar 

  10. 10

    Hofstetter CP, Nanaszko MJ, Mubita LL, Tsiouris J, Anand VK, Schwartz TH. Volumetric classification of pituitary macroadenomas predicts outcome and morbidity following endoscopic endonasal transsphenoidal surgery. Pituitary 2012; 15: 450–463.

    Article  Google Scholar 

  11. 11

    Paluzzi A, Fernandez-Miranda JC, Tonya Stefko S, Challinor S, Snyderman CH, Gardner PA. Endoscopic endonasal approach for pituitary adenomas: a series of 555 patients. Pituitary 2014;17:307–319.

    Article  Google Scholar 

  12. 12

    Hofstetter CP, Shin BJ, Mubita L, Huang C, Anand VK, Boockvar JA, Schwartz TH. Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas. Neurosurg Focus 2011;30(4):E10.

    Article  Google Scholar 

  13. 13

    Messerer M, de Battista JC, Raverot G, Kassis S, Dubourg J, Lapras V et al. Evidence of improved surgical outcome following endoscopy for nonfunctioning pituitary adenoma removal: personal experience and review of the literature. Neurosurg Focus 2011; 30: E11.

    Article  Google Scholar 

  14. 14

    Chabot JD, Chakraborty S, Imbarrato G, Dehdashti AR. Evaluation of outcomes after endoscopic endonasal surgery for large and giant pituitary macroadenoma: a retrospective review of 39 consecutive patients. World Neurosurg 2015; 84: 978–988.

    Article  Google Scholar 

  15. 15

    D’Haens J, van Rompaey K, Stadnik T, Haentjens P, Poppe K, Velkeniers B. Fully endoscopic transsphenoidal surgery for functioning pituitary adenomas: a retrospective comparison with traditional transsphenoidal microsurgery in the same institution. Surg Neurol 2009; 72: 336–340.

    Article  Google Scholar 

  16. 16

    Laufer I, Anand VK, Schwartz TH. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 2007; 106: 400–406.

    Article  Google Scholar 

  17. 17

    Knosp E, Steiner E, Kitz K, Matula C. Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 1993; 33: 610–617. discussion 617–618.

    CAS  PubMed  Google Scholar 

  18. 18

    Mohr G, Hardy J, Comtois R, Beauregard H. Surgical management of giant pituitary adenomas. Can J Neurol Sci 1990; 17: 62–66.

    CAS  Article  Google Scholar 

  19. 19

    Lissett CA, Shalet SM. Management of pituitary tumours: strategy for investigation and follow-up. Horm Res 2000;53(Suppl 3):65–70.

    CAS  PubMed  Google Scholar 

  20. 20

    Melmed S, Casanueva F, Cavagnini F, Chanson P, Frohman LA, Gaillard R et al. Consensus statement: medical management of acromegaly. Eur J Endocrinol 2005; 153: 737–740.

    CAS  Article  Google Scholar 

  21. 21

    Giustina A, Barkan A, Casanueva FF, Cavagnini F, Frohman L, Ho K et al. Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 2000; 85: 526–529.

    CAS  PubMed  Google Scholar 

  22. 22

    Vance ML. Perioperative management of patients undergoing pituitary surgery. Endocrinol Metab Clin North Am 2003; 32: 355–365.

    Article  Google Scholar 

  23. 23

    Arnaldi G, Angeli A, Atkinson AB, Bertagna X, Cavagnini F, Chrousos GP et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. J Clin Endocrinol Metab 2003; 88: 5593–5602.

    CAS  Article  Google Scholar 

  24. 24

    Rees DA, Hanna FW, Davies JS, Mills RG, Vafidis J, Scanlon MF. Long-term follow-up results of transsphenoidal surgery for Cushing’s disease in a single centre using strict criteria for remission. Clin Endocrinol (Oxf) 2002; 56: 541–551.

    CAS  Article  Google Scholar 

  25. 25

    Liu JK, Das K, Weiss MH, Laws ER Jr, Couldwell WT. The history and evolution of transsphenoidal surgery. J Neurosurg 2001; 95: 1083–1096.

    CAS  Article  Google Scholar 

  26. 26

    Cappabianca P, de Divitiis E. Endoscopic endonasal transsphenoidal surgery. Management of pituitary tumors. Springer; 2003:161–171.

  27. 27

    McDonald T, Laws Jr E. Historical aspects of the management of pituitary disorders with emphasis on transsphenoidal surgery. The management of pituitary adenomas and related lesions with emphasis on transsphenoidal microsurgery. New York, NY: Appleton-Century-Crofts; 1982:1–13.

    Google Scholar 

  28. 28

    Jho HD, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 1997; 87: 44–51.

    CAS  Article  Google Scholar 

  29. 29

    De Divitiis E, Cappabianca P, Cavallo L. Endoscopic endonasal transsphenoidal approach to the sellar region. Endoscopic endonasal transsphenoidal surgery. Springer; 2003:91–130.

  30. 30

    Gondim JA, Schops M, de Almeida JP, de Albuquerque LA, Gomes E, Ferraz T, Barroso FA. Endoscopic endonasal transsphenoidal surgery: surgical results of 228 pituitary adenomas treated in a pituitary center. Pituitary 2010; 13: 68–77.

    Article  Google Scholar 

  31. 31

    Frank G, Pasquini E, Farneti G, Mazzatenta D, Sciarretta V, Grasso V, Faustini Fustini M. The endoscopic versus the traditional approach in pituitary surgery. Neuroendocrinology 2006; 83: 240–248.

    CAS  Article  Google Scholar 

  32. 32

    Jho H-D. Endoscopic transsphenoidal surgery. J Neurooncol 2001; 54: 187–195.

    CAS  Article  Google Scholar 

  33. 33

    Lampropoulos KI, Samonis G, Nomikos P. Factors influencing the outcome of microsurgical transsphenoidal surgery for pituitary adenomas: a study on 184 patients. Hormones (Athens) 2013; 12: 254–264.

    Article  Google Scholar 

  34. 34

    Elkington SG, McKissock W. Pituitary adenoma: results of combined surgical and radiotherapeutic treatment of 260 patients. Br Med J 1967; 1: 263–266.

    CAS  Article  Google Scholar 

  35. 35

    Guiot J, Rougerie J, Fourestier M, Fournier A, Comoy C, Vulmiere J, Groux R. Intracranial endoscopic explorations. Presse Med 1963; 71: 1225–1228.

    CAS  PubMed  Google Scholar 

  36. 36

    Honegger J, Ernemann U, Psaras T, Will B. Objective criteria for successful transsphenoidal removal of suprasellar nonfunctioning pituitary adenomas. A prospective study. Acta Neurochir (Wien) 2007; 149: 21–29.

    CAS  Article  Google Scholar 

  37. 37

    Jefferson G. Extrasellar extensions of pituitary adenomas: (section of neurology). Proc R Soc Med 1940; 33: 433–458.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. 38

    Hardy J, Vezina JL. Transsphenoidal neurosurgery of intracranial neoplasm. Adv Neurol 1976; 15: 261–273.

    CAS  PubMed  Google Scholar 

  39. 39

    Wilson CB. A decade of pituitary microsurgery. The Herbert Olivecrona lecture. J Neurosurg 1984; 61: 814–833.

    CAS  Article  Google Scholar 

  40. 40

    Kitano M, Taneda M, Shimono T, Nakao Y. Extended transsphenoidal approach for surgical management of pituitary adenomas invading the cavernous sinus. J Neurosurg 2008; 108: 26–36.

    Article  Google Scholar 

  41. 41

    Chang EF, Zada G, Kim S, Lamborn KR, Quinones-Hinojosa A, Tyrrell JB et al. Long-term recurrence and mortality after surgery and adjuvant radiotherapy for nonfunctional pituitary adenomas. J Neurosurg 2008; 108: 736–745.

    Article  Google Scholar 

  42. 42

    Park P, Chandler WF, Barkan AL, Orrego JJ, Cowan JA, Griffith KA, Tsien C. The role of radiation therapy after surgical resection of nonfunctional pituitary macroadenomas. Neurosurgery 2004; 55: 100–106. discussion 106–106.

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Mostafa Ismail MD.

Additional information

Conflicts of interest

There are no conflicts of interest.

Rights and permissions

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.

To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ismail, M., Abdelhak, B., D’Haens, J. et al. Endoscopic endonasal transsphenoidal surgery: predictors for disease control in a consecutive series of pituitary adenomas. Egypt J Otolaryngol 32, 130–140 (2016). https://doi.org/10.4103/1012-5574.186523

Download citation

Keywords

  • disease control