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Intraoperative unfolding and postoperative pruning of the pituitary gland after transsphenoidal surgery for pituitary adenoma: A volumetric and endocrinological evaluation

  • Endocrine Surgery
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Abstract

Purpose

To describe the volumetric changes that the pituitary gland (PG) undergoes during and after transsphenoidal surgery (TSS), and to evaluate if unfolding and/or pruning are related to endocrinological outcome measures.

Methods

Retrospective evaluation of data prospectively collected of a cohort of patients undergoing TSS for a pituitary adenoma with the adjunctive use of high field 3 Tesla intraoperative MRI. All patients underwent a full endocrinological workup preoperatively, as well as at 6 weeks and 1 year postoperatively. A decrease in PG volume ≥15% between the intraoperative and 3-month, or between the 3-month and 12-month measurements, was considered early and late pruning, respectively.

Results

The PG unfolds significantly during TSS, and subsequently undergoes pruning up until 1 year postoperatively, in most cases returning to the preoperatively measured PG volume. A smaller baseline PG volume predicts intraoperative unfolding. Early pruning of the PG after surgery was associated with new functional deficits. Baseline pituitary compression also correlated to newly occurring deficits after surgery. A larger 1-year pituitary volume was associated with biochemical remission in secreting adenomas.

Conclusions

The PG shows dynamic change during and after TSS for pituitary adenoma. Small baseline and 3-month PG volumes, as well as early pruning were independently associated with new deficits. Our findings warrant prospective validation in a larger cohort with higher statistical power.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

    Authors and Affiliations

    1. Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland

      Victor E. Staartjes, Nicolai Maldaner, Jan-Karl Burkhardt, Carlo Serra & Luca Regli

    2. Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland

      Sarah Stricker

    3. Department of Neurosurgery, Tuscany School of Neurosurgery, University of Firenze, Firenze, Italy

      Giovanni Muscas

    4. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland

      David Holzmann

    5. Department of Biostatistics; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland

      Burkhardt Seifert

    6. Department of Endocrinology and Diabetes, University Hospital Zurich, University of Zurich, Zurich, Switzerland

      Christoph Schmid

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    1. Victor E. Staartjes
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    Correspondence to Carlo Serra.

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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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

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    These authors contributed equally: Victor Staartjes, Sarah Stricker.

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    Staartjes, V.E., Stricker, S., Muscas, G. et al. Intraoperative unfolding and postoperative pruning of the pituitary gland after transsphenoidal surgery for pituitary adenoma: A volumetric and endocrinological evaluation. Endocrine 63, 231–239 (2019). https://doi.org/10.1007/s12020-018-1758-2

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