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Outcome of nonneoplastic pituitary cysts during conservative monitoring and after surgery—a SwissPit study

  • Original Article - Pituitaries
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Abstract

Background

Nonneoplastic cysts of the pituitary are common incidental findings; however, best management remains controversial as they are often asymptomatic but eventually may cause symptoms. The aims of this study are to describe the course of conservative and surgical approaches, to assess timing and results of surgery, and to identify predictors for growth.

Methods

This retrospective study reviewed medical records from the Swiss Pituitary registry. Fifty patients (68% females; median 44 years old) fulfilled the criteria for inclusion. Three cohorts were defined: a conservative group (n = 28), a group who initially needed surgery (n = 18), and a group who had surgery during follow-up (n = 4). Transsphenoidal cyst evacuation was used in 95%; 68% had intraoperative MRI. All patients had standardized neuroradiological, endocrinological, and ophthalmological follow-up (mean 44 (7–151) months).

Results

Conservative follow-up of 30 (6–120) months showed cyst growth in 16% (4%/year) and spontaneous shrinkage in 19% (8%/year). Cyst-volumes changed − 0.95 to 1.45 cm3 per year. The probability of needing surgery was 5% per year. Larger cysts (> 1.4 cm3) and T1-hypo-/T2-hyper cyst contents were associated with higher probability for growth. Postoperatively, no remnant was seen in 82% during a follow-up of 53 months. Visual field deficiencies improved in 83%. Hypopituitarism recovered in up to 88%. But for a smaller complication rate, the outcome was not influenced by the use of the intraoperative MRI.

Conclusions

Asymptomatic nonneoplastic pituitary cysts may be monitored; many lesions may shrink with time. Larger or T1-hypo-/T2-hyper cysts have higher growth rates. If indicated, surgery for nonneoplastic sellar cysts is a safe and efficient.

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Funding

This study was funded by the research grant of the Kantonsspital Aarau AG, Aarau, Switzerland (Award Number: 1410.000.069).

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Author notes

  1. Sven Berkmann and Patrick Schwyzer contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland

    Sven Berkmann, Patrick Schwyzer & Javier Fandino

  2. Division of Endocrinology, Diabetology and Metabolism, Univ. Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland

    Philipp Schuetz & Beat Mueller

  3. Division of Neuroradiology, Department of Radiology, Kantonsspital Aarau, Aarau, Switzerland

    Luca Remonda

Authors
  1. Sven Berkmann
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  2. Patrick Schwyzer
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  3. Philipp Schuetz
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  4. Luca Remonda
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  5. Beat Mueller
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  6. Javier Fandino
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Contributions

Conceptualization: Sven Berkmann, Patrick Schwyzer;

Data curation: Sven Berkmann, Patrick Schwyzer;

Methodology: Sven Berkmann, Patrick Schwyzer;

Formal analysis and investigation: Sven Berkmann, Patrick Schwyzer;

Writing - original draft preparation: Sven Berkmann, Patrick Schwyzer;

Writing - review and editing: all authors;

Funding acquisition: Sven Berkmann;

Resources: Sven Berkmann;

Supervision: Sven Berkmann, Javier Fandino.

Corresponding author

Correspondence to Sven Berkmann.

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Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Ethical approval

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. The study was approved by the local ethical committee (EKNZ 2015-375).

Informed consent

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

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This article is part of the Topical Collection on Pituitaries

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Berkmann, S., Schwyzer, P., Schuetz, P. et al. Outcome of nonneoplastic pituitary cysts during conservative monitoring and after surgery—a SwissPit study. Acta Neurochir 162, 2389–2396 (2020). https://doi.org/10.1007/s00701-020-04467-7

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  • DOI: https://doi.org/10.1007/s00701-020-04467-7

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