Download PDF
J Neurol Surg B Skull Base 2024; 85(05): 501-508
DOI: 10.1055/a-2095-6442
Original Article

Anatomical-Radiological Aspects and Their Influence on the Results of Pituitary Adenomas Endoscopic Endonasal Surgery

A. Kuptsov 
1   Department of Neurosurgery, Hospital General Universitario de Alicante, Alicante, Spain
,
J. Abarca-Olivas 
1   Department of Neurosurgery, Hospital General Universitario de Alicante, Alicante, Spain
,
I. Monjas-Cánovas
2   Department of Otorhinolaryngology, Hospital General Universitario de Alicante, Alicante, Spain
,
T. Argüello-Gordillo
3   Department of Endocrinology, Hospital General Universitario de Alicante, Alicante, Comunidad Valenciana, Spain
,
A. Picó-Alfonso
3   Department of Endocrinology, Hospital General Universitario de Alicante, Alicante, Comunidad Valenciana, Spain
,
J. Sánchez-Payá
4   Department of Epidemiology, Hospital General Universitario de Alicante, Alicante, Spain
,
J. A. Nieto-Navarro
1   Department of Neurosurgery, Hospital General Universitario de Alicante, Alicante, Spain
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Introduction Endoscopic endonasal surgery has globally improved postoperative results in pituitary adenomas.

Material and Methods We retrospectively analyzed 101 patients who underwent endonasal endoscopic surgery for pituitary adenomas in the period from 2016 to 2021. Data on epidemiological variables, preoperative radiological factors including tumor volume, tumor appearance, cavernous sinus invasion (modified Knosp scale), degree of extension according to the SIPAP (stands for the five directions in which a pituitary adenoma can extend: suprasellar, infrasellar, parasellar, anterior, and posterior) classification, and preoperative visualization of the healthy gland on magnetic resonance imaging (MRI) were collected as well as intra- and postoperative cerebrospinal fluid (CSF) leak. As variables of interest, data on the degree of tumoral resection and preservation of hormonal function were collected.

Results Among the preoperative factors related to greater tumoral resection, we found a lesser tumoral extension according to the SIPAP scale, and the absence of a postoperative CSF leak had a statistically significant relation with greater hormonal preservation.

Conclusion The SIPAP classification is a simple-to-measure preoperative radiological variable that could predict the extent of resection, and, conversely, the occurrence of a postoperative CSF leak has been associated with an inferior endocrinological outcome in this type of surgery.

Keywords

pituitary adenoma - endoscopic endonasal approach - hormonal deficiency - CSF leak - sellar barrier - Knosp - SIPAP


Publication History

Received: 25 February 2023

Accepted: 13 May 2023

Accepted Manuscript online:
17 May 2023

Article published online:
15 June 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Ezzat S, Asa SL, Couldwell WT. et al. The prevalence of pituitary adenomas: a systematic review. Cancer 2004; 101 (03) 613-619
    CrossrefPubMedGoogle Scholar
  • 2 Niveiro de Jaime M, Aranda López FI, Peiró Cabrera G. Patología de los adenomas hipofisarios. Rev Esp Patol 2003; 36 (04) 357-372
    PubMedGoogle Scholar
  • 3 Fontana E, Gaillard R. [Epidemiology of pituitary adenoma: results of the first Swiss study]. Rev Med Suisse 2009; 5 (223) 2172-2174
    PubMedGoogle Scholar
  • 4 Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A. High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab 2006; 91 (12) 4769-4775
    CrossrefPubMedGoogle Scholar
  • 5 Dehdashti AR, Ganna A, Karabatsou K, Gentili F. Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery 2008; 62 (05) 1006-1015 , discussion 1015–1017
    PubMedGoogle Scholar
  • 6 Goudakos JK, Markou KD, Georgalas C. Endoscopic versus microscopic trans-sphenoidal pituitary surgery: a systematic review and meta-analysis. Clin Otolaryngol 2011; 36 (03) 212-220
    CrossrefPubMedGoogle Scholar
  • 7 Regmi D, Thapa A, Kc B, Shakya B. Endoscopic endonasal transsphenoidal approach to pituitary adenoma: a multi-disciplinary approach. J Nepal Health Res Counc 2017; 15 (02) 174-177
    CrossrefPubMedGoogle Scholar
  • 8 Villalonga JF, Solari D, Cavallo LM. et al. The sellar barrier on preoperative imaging predicts intraoperative cerebrospinal fluid leak: a prospective multicenter cohort study. Pituitary 2021; 24 (01) 27-37
    CrossrefPubMedGoogle Scholar
  • 9 Abellán Galiana P, Fajardo Montañana C, Riesgo Suárez PA, Gómez Vela J, Escrivá CM, Lillo VR. Factores pronósticos de remisión a largo plazo tras cirugía transesfenoidal en la enfermedad de Cushing. Endocrinol Nutr 2013; 60 (08) 475-482
    CrossrefPubMedGoogle Scholar
  • 10 Giustina A, Barkan A, Casanueva FF. et al. Criteria for cure of acromegaly: a consensus statement. J Clin Endocrinol Metab 2000; 85 (02) 526-529
    CrossrefPubMedGoogle Scholar
  • 11 Fang Y, Pei Z, Chen H. et al. Diagnostic value of Knosp grade and modified Knosp grade for cavernous sinus invasion in pituitary adenomas: a systematic review and meta-analysis. Pituitary 2021; 24 (03) 457-464
    CrossrefPubMedGoogle Scholar
  • 12 López-García R, Abarca-Olivas J, Monjas-Cánovas I, Picó Alfonso A, Moreno-López P, Gras-Albert JR. Cirugía endoscópica endonasal en adenomas hipofisarios: resultados quirúrgicos en una serie de 86 pacientes consecutivos. Neurocirugia (Astur) 2018; 29 (04) 161-169
    CrossrefPubMedGoogle Scholar
  • 13 Enseñat J, Ortega A, Topcewski T. et al. Valor predictivo de la clasificación de Knosp en el grado de resección quirúrgica de los macroadenomas invasivos. Estudio prospectivo de una serie de 23 casos. Neurocirugia (Astur) 2006; 17 (06) 519-526
    CrossrefPubMedGoogle Scholar
  • 14 Micko A, Oberndorfer J, Weninger WJ. et al. Challenging Knosp high-grade pituitary adenomas. J Neurosurg 2019; 132 (06) 1739-1746
    CrossrefPubMedGoogle Scholar
  • 15 Cao L, Chen H, Hong J, Ma M, Zhong Q, Wang S. Magnetic resonance imaging appearance of the medial wall of the cavernous sinus for the assessment of cavernous sinus invasion by pituitary adenomas. J Neuroradiol 2013; 40 (04) 245-251
    CrossrefPubMedGoogle Scholar
  • 16 Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of giant pituitary adenomas. Pituitary 2012; 15 (02) 150-159
    CrossrefPubMedGoogle Scholar
  • 17 Edal AL, Skjödt K, Nepper-Rasmussen HJ. SIPAP: a new MR classification for pituitary adenomas. Suprasellar, infrasellar, parasellar, anterior and posterior. Acta Radiol 1997; 38 (01) 30-36
    CrossrefPubMedGoogle Scholar
  • 18 Cho CH, Barkhoudarian G, Hsu L, Bi WL, Zamani AA, Laws ER. Magnetic resonance imaging validation of pituitary gland compression and distortion by typical sellar pathology. J Neurosurg 2013; 119 (06) 1461-1466
    CrossrefPubMedGoogle Scholar
  • 19 Chohan MO, Levin AM, Singh R. et al. Three-dimensional volumetric measurements in defining endoscope-guided giant adenoma surgery outcomes. Pituitary 2016; 19 (03) 311-321
    CrossrefPubMedGoogle Scholar
  • 20 Sol YL, Lee SK, Choi HS, Lee YH, Kim J, Kim SH. Evaluation of MRI criteria for cavernous sinus invasion in pituitary macroadenoma. J Neuroimaging 2014; 24 (05) 498-503
    CrossrefPubMedGoogle Scholar
  • 21 Dallapiazza RF, Grober Y, Starke RM, Laws Jr ER, Jane Jr JA. Long-term results of endonasal endoscopic transsphenoidal resection of nonfunctioning pituitary macroadenomas. Neurosurgery 2015; 76 (01) 42-52 , discussion 52–53
    CrossrefPubMedGoogle Scholar
  • 22 Yano S, Kawano T, Kudo M. et al. Endoscopic endonasal transsphenoidal approach through the bilateral nostrils for pituitary adenomas. Neurol Med Chir (Tokyo) 2009; 49 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 23 Meij BP, Lopes MB, Ellegala DB, Alden TD, Laws Jr ER. The long-term significance of microscopic dural invasion in 354 patients with pituitary adenomas treated with transsphenoidal surgery. J Neurosurg 2002; 96 (02) 195-208
    CrossrefPubMedGoogle Scholar
  • 24 Alahmari M, Lasso A, Banaz F. et al. Utilization of SiPAP classification in prediction of pituitary adenoma recurrence: The Ottawa hospital experience. Paper presented at: Special Virtual Symposium of the North American Skull Base Society; February 13, 2021
    PubMedGoogle Scholar
  • 25 Alexopoulou O, Everard V, Etoa M. et al. Outcome of pituitary hormone deficits after surgical treatment of nonfunctioning pituitary macroadenomas. Endocrine 2021; 73 (01) 166-176
    CrossrefPubMedGoogle Scholar
  • 26 Nemergut EC, Zuo Z, Jane Jr JA, Laws Jr ER. Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg 2005; 103 (03) 448-454
    CrossrefPubMedGoogle Scholar
  • 27 Gormolysova E. Prevalence of diabetes insipidus and other complications in early period after pituitary surgery: analysis of 259 patients. Biomed J Sci Tech Res 2022; 41 (02) 32565-32572
    PubMedGoogle Scholar
  • 28 Biamonte E, Betella N, Milani D. et al. Impact of age on postsurgical outcomes of nonfunctioning pituitary adenomas. Endocrine 2021; 72 (03) 915-922
    CrossrefPubMedGoogle Scholar
  • 29 Nomikos P, Ladar C, Fahlbusch R, Buchfelder M. Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas: a study on 721 patients. Acta Neurochir (Wien) 2004; 146 (01) 27-35
    CrossrefPubMedGoogle Scholar
  • 30 Magro E, Graillon T, Lassave J. et al. Complications related to the endoscopic endonasal transsphenoidal approach for nonfunctioning pituitary macroadenomas in 300 consecutive patients. World Neurosurg 2016; 89: 442-453
    CrossrefPubMedGoogle Scholar
  • 31 Rojas ZD, Palma FA, Wohllk GN. Manejo de los adenomas hipofisiarios. Rev Chil Neuro-psiquiatr 2008; 46 (02) 140-147
    CrossrefPubMedGoogle Scholar