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Craniocaudal Extension as an Indication of Surgical Outcome in Transsphenoidal Surgery for Pituitary Adenomas

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Transsphenoidal approach is considered the treatment of choice for pituitary adenoma removal. Suprasellar extension is regarded a drawback for complete removal of these tumors through this approach. Evaluate the correlation between the preoperative radiologic craniocaudal extension on MRI of pituitary adenomas and the extent of tumor removal. A retrospective study. Tertiary care hospital. 560 patients underwent transsphenoidal removal of pituitary adenomas. The degree of removal of pituitary tumor in the follow-up imaging of the patients was correlated with the preoperative extension in mid-Coronal T1 W Gd. Tumors with suprasellar extension can be classified into: Type I tumors with extension confined to the sellar boundaries, resulted in complete removal in all cases (100%), type II tumors with suprasellar extension reaching the floor of the 3rd ventricle, resulted in complete removal in 70.2% of the cases, type III tumors with suprasellar extension above the 3rd ventricle, had only 13.5% of complete removal. Integration of radiologic findings into a scheme for the preoperative determination of possibility of total removal of the tumor through transsphenoidal approach, can give better correlation to the surgical outcome of pituitary tumors.

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Abbreviations

WHO:

World Health Organization

H–W:

Hardy–Wilson classification

TSA:

Transsphenoidal adenomectomy

References

  1. Asa SL (1998) Tumors of the pituitary gland. In: Atlas of tumor pathology, series 3, Fascicle 22. Armed Forces Institute of Pathology, Washington, DC

  2. Ezzat S, Asa SL (2006) Mechanisms of disease: the pathogenesis of pituitary tumors. Nat Clin Pract Endocrinol Metab 2(4):220–230

    Article  PubMed  CAS  Google Scholar 

  3. Kovacs K, Horvath E, Vidal S (2001) Classification of pituitary adenomas. J Neurooncol 54:121–127

    Article  PubMed  CAS  Google Scholar 

  4. Hardy J (1973) Transsphenoidal surgery of hypersecreting pituitary tumors. In: Kohler PO, Ross GT (eds). Diagnosis and treatment of pituitary tumors. ICS, vol 303 Exerpta Medica, Amsterdam, pp 179–198

  5. Yeh PJ, Chen JW (1997) Pituitary tumors: surgical and medical management. Surg Oncol 6(2):67–92

    Article  PubMed  CAS  Google Scholar 

  6. Ezzat S, Asa S, Couldwell W et al (2004) The prevalence of pituitary adenomas: a systematic review. Cancer 101(3):613–619

    Article  PubMed  Google Scholar 

  7. Saeger W, Ludecke D, Buchfelder M, Fahlbusch R, Quabbe H, Petersenn S (2007) Pathohistological classification of pituitary tumors: 10 years of experience with the German pituitary tumor registry. Eur J Endocrinol 156:203–216

    Article  PubMed  CAS  Google Scholar 

  8. Ezzat S, Asa S, Couldwell W, Barr C, Dodge W, Vance ML, McCutcheon I (2004) The prevalence of pituitary adenomas: a systematic review. Cancer 101(3):613–619

    Google Scholar 

  9. Asa S, Ezzat S (1998) The cytogenesis and pathogenesis of pituitary adenomas. Endocr Rev 19:798–827

    Article  PubMed  CAS  Google Scholar 

  10. Kovacs K, Scheithauer B, Horvath E, Lloyd R (1996) The World Health Organization classification of adenohypophysial neoplasms. A Proposed Five-Tier Scheme. Cancer 78(3):502–510

  11. Couldwell W (2004) Transsphenoidal and transcranial surgery for pituitary adenomas. J Neurooncol 69(1–3):237–256

    Article  PubMed  Google Scholar 

  12. Kanter AS, Dumont AS, Asthagiri AR, Oskouian RJ, Jane JA Jr, Laws ER Jr (2005) The transsphenoidal approach. A historical perspective. Neurosurg Focus 18(4):e6

    Google Scholar 

  13. Joshi SM, Cudlip S (2008) Transsphenoidal surgery. Pituitary 11(4):353–360

    Article  PubMed  Google Scholar 

  14. Gandhi CD, Christiano LD, Eloy JA, Prestigiacomo CJ, Post KD (2009) The historical evolution of transsphenoidal surgery: facilitation by technological advances. Neurosurg Focus 27(3):E8

    Article  PubMed  Google Scholar 

  15. Liu J, Weiss M, Couldwell W (2003) Surgical approaches to pituitary tumors. Neurosurg Clin N Am 14(1):93–107

    Article  PubMed  Google Scholar 

  16. Chang E, Sughrue M, Zada G, Wilson C, Jr Blevins L, Kunwar S (2010) Long term outcome following repeat transsphenoidal surgery for recurrent endocrine-inactive pituitary adenomas. Pituitary 13:223–229

    Article  PubMed  Google Scholar 

  17. Youssef AS, Agazzi S, van Loveren HR (2005) Transcranial surgery for pituitary adenomas. Neurosurgery 57(1 Suppl):168–175

    Article  PubMed  Google Scholar 

  18. Abe T, Iwata T, Kawamura N, Izumiyama H, Ikeda H, Matsumoto K (1997) Staged transsphenoidal surgery for fibrous nonfunctioning pituitary adenomas with suprasellar extension. Neurol Med Chir (Tokyo) 37:830–837

    Article  CAS  Google Scholar 

  19. Naganuma H, Satoh E, Nukui H (2002) Technical considerations of transsphenoidal removal of fibrous pituitary adenomas and evaluation of collagen content and subtype in adenomas. Neurol Med Chir (Tokyo) 42:202–213

    Article  Google Scholar 

  20. Kouri JG, Chen MY, Watson JC, Oldfield EH (2000) Resection of suprasellar tumors by using a modified transsphenoidal approach. Report of four cases. J Neurosurg 92(6):1028–1035

    Article  PubMed  CAS  Google Scholar 

  21. Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T (2004) Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 55(3):539–547

    Article  PubMed  Google Scholar 

  22. Laufer I, Anand VK, Schwartz TH (2007) Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 106(3):400–406

    Article  PubMed  Google Scholar 

  23. Nejadkazem M, Samii A, Fahlbusch R, Bidadi S (2008) A simplified direct endonasal approach for transsphenoidal surgery. Minim Invasive Neurosurg 51(5):272–274

    Article  PubMed  CAS  Google Scholar 

  24. Jain AK, Gupta AK, Pathak A, Bhansali A, Bapuraj JR (2008) Endonasal transsphenoidal pituitary surgery: Is tumor volume a key factor in determining outcome? Am J Otolaryngol 29(1):48–50

    Article  PubMed  Google Scholar 

  25. Honegger J, Ernemann U, Psaras T, Will B (2007) Objective criteria for successful transsphenoidal removal of suprasellar nonfunctioning pituitary adenomas. A prospective study. Acta Neurochir (Wien) 149(1):21–29

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department Otorhinolaryngology, Ain Shams University, 50, El Hegaz Street, Heliopolis, Cairo, Egypt

    Ossama Hamid

  2. Department Neurosurgery, Ain Shams University, 18, El Mansoura Street, Heliopolis, Cairo, Egypt

    Adel El Hakim

  3. Department Neurosurgery, Ain Shams University, 72 Misr & El Sudan Street, Hadayek El Kubba, Cairo, Egypt

    Hossam El Husseiny

  4. Department Otorhinolaryngology, Ain Shams University, 48 Ibn El Nafees Street, 6th District, Madinet Nasr, Cairo, 11371, Egypt

    Lobna El Fiky

  5. Department Otorhinolaryngology, Ain Shams University, 45, Gamal ElDin Dewidar, Madinet Nasr, Cairo, Egypt

    Sherif Kamel

Authors
  1. Ossama Hamid
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  2. Adel El Hakim
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  3. Hossam El Husseiny
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  4. Lobna El Fiky
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  5. Sherif Kamel
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Correspondence to Lobna El Fiky.

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Hamid, O., El Hakim, A., El Husseiny, H. et al. Craniocaudal Extension as an Indication of Surgical Outcome in Transsphenoidal Surgery for Pituitary Adenomas. Indian J Otolaryngol Head Neck Surg 65 (Suppl 2), 231–235 (2013). https://doi.org/10.1007/s12070-011-0350-3

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  • DOI: https://doi.org/10.1007/s12070-011-0350-3

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