Trans-Sphenoidal Surgery for "Growth Hormone-secreting adenoma; Revisiting Surgical Outcome

Year 2021, Volume: 7 Issue: 2, 205 - 211, 31.08.2021

Bülent Özdemir , Osman Ersegun Batcik

https://doi.org/10.19127/mbsjohs.949050

Abstract

Objective: The purpose of this research is to review our clinical experience in transsphenoidal surgery for pituitary adenomas performed by Recep Tayyip Erdogan University Faculty of Medicine, Department of Neurosurgery and contribute to the literature in this way.

Methods: This is a case review of Growth Hormone secreting pituitary adenoma operated in the Recep Tayyip Erdogan University Faculty of Medicine Department of Neurosurgery from January 2014 to May 2021. All patients underwent a microscopic transnasal approach. It was aimed gross total excision of adenoma. For functioning adenomas, hormonal assessment was done on follow-up (8 weeks) and remission was said to be achieved if normal hormonal levels were achieved along with gross total tumor removal. Surgical complications were evaluated, and postoperative follow-up with laboratory and imaging studies were performed.

Results: 78 patients were operated by trans nasal route in our hospital between January 2014-June 2021. Of these 78 pituitary tumors, 22 were growth hormone secreting adenoma. The study population consisted of 22 people, 11 men and 11 women, and the average age of the population was calculated as 60.45 years ± 18.4. Statistical analysis showed that the difference between the pre-operative and post-operative somamedine and growth hormone level was statistically significant

Conclusions: Microscopic Trans-Sphenoidal Surgery for Acromegalic patients is a minimally invasive, safe, and efficacious choice

Keywords

Trans-sphenoidal, surgery, pituitary, adenoma

References

• 1. Koirala S, Shrestha BK, Lohani S, Bishokarma S, Devkota UP. Postoperative Complications of Transsphenoidal Pituitary Adenectomy: A Single Institution Based Experience. Kathmandu Univ Med J (KUMJ). 2019;17(66):123–5.
• 2. Van Gerven L, Qian Z, Starovoyt A, Jorissen M, Meulemans J, van Loon J, et al. Endoscopic, Endonasal Transsphenoidal Surgery for Tumors of the Sellar and Suprasellar Region: A Monocentric Historical Cohort Study of 369 Patients. Front Oncol. 2021;11:643550.
• 3. Li J, Ding W, Huang Z, Xie B, Li Z-Y. Comparison of Short-Term Outcomes Between Endoscopic and Microscopic Trans-Sphenoidal Surgery for the Treatment of Pituitary Adenoma. J Craniofac Surg. 2019;30(8):2421–4.
• 4. Müslüman AM, Cansever T, Yilmaz A, Kanat A, Oba E, Çavuşoǧlu H, et al. Surgical results of large and giant pituitary adenomas with special consideration of ophthalmologic outcomes. World Neurosurg. 2011;76(1–2).
• 5. Thakur JD, Corlin A, Mallari RJ, Huang W, Eisenberg A, Sivakumar W, et al. Pituitary adenomas in older adults (≥ 65 years): 90-day outcomes and readmissions: a 10-year endoscopic endonasal surgical experience. Pituitary. 2021;24(1):14–26.
• 6. Villar-Taibo R, Díaz-Ortega C, Sifontes-Dubon M, Fernández-Pombo A, Serramito-García R, Martínez-Capoccioni G, et al. Pituitary surgery in elderly patients: a safe and effective procedure. Endocrine. 2021;72(3):814–22.
• 7. Thakkar K, Sarathi V, Shah NS. Current Status of Diagnosis and Management for Functioning Pituitary Tumors: Part I. Neurol India. 2020;68:13–9.
• 8. Karamouzis I, Caputo M, Mele C, Nuzzo A, Zavattaro M, Car P, et al. Transsphenoidal surgery for pituitary adenomas: early results from a single center. Hormones (Athens). 2018;17(4):551–6.
• 9. Jain AK, Gupta AK, Pathak A, Bhansali A, Bapuraj JR. Excision of pituitary adenomas: randomized comparison of surgical modalities. Br J Neurosurg. 2007;21(4):328–31.
• 10. Møller MW, Andersen MS, Glintborg D, Pedersen CB, Halle B, Kristensen BW, et al. Endoscopic vs. microscopic transsphenoidal pituitary surgery: a single centre study. Sci Rep. 2020;10(1):21942.
• 11. Mattogno PP, Mangiola A, Lofrese G, Vigo V, Anile C. Efficacy of Microsurgical Sublabial Approach (MSA) Versus Endoscopic Endonasal Approach (EEA) for the Treatment of Pituitary Adenomas Based on Radiological and Hormonal Outcome. Acta Neurochir Suppl. 2017;124:101–6.
• 12. Shen M, Tang Y, Shou X, Wang M, Zhang Q, Qiao N, et al. Surgical Results and Predictors of Initial and Delayed Remission for Growth Hormone-Secreting Pituitary Adenomas Using the 2010 Consensus Criteria in 162 Patients from a Single Center. World Neurosurg. 2018; 27;S1878-8750(18)32738-4. doi: 10.1016/j.wneu.2018.11.179.
• 13. Goyal-Honavar A, Sarkar S, Asha HS, Kapoor N, Thomas R, Balakrishnan R, et al. Impact of experience on outcomes following endoscopic transsphenoidal surgery for acromegaly. World Neurosurg. 2021; 151:e1007-e1015. doi: 10.1016/j.wneu.2021.05.030.
• 14. Coopmans EC, Postma MR, Wolters TLC, van Meyel SWF, Netea-Maier R, van Beek AP, et al. Predictors for Remission after Transsphenoidal Surgery in Acromegaly: A Dutch Multicenter Study. J Clin Endocrinol Metab. 2021;106(6):1783–92.
• 15. Braileanu M, Hu R, Hoch MJ, Mullins ME, Ioachimescu AG, Oyesiku NM, et al. Pre-operative MRI predictors of hormonal remission status post pituitary adenoma resection. Clin Imaging. 2019;55:29–34.
• 16. Asioli S, Righi A, Iommi M, Baldovini C, Ambrosi F, Guaraldi F, et al. Validation of a clinicopathological score for the prediction of post-surgical evolution of pituitary adenoma: retrospective analysis on 566 patients from a tertiary care centre. Eur J Endocrinol. 2019;180(2):127–34.
• 17. Jamjoom ZA, Al-Maatouq M, Jamjoom AH, Malabarey T, Al-Rubeaan K, Ur-Rahman N, et al. Growth hormone secreting pituitary adenoma: Clinical aspects and surgical outcome. Ann Saudi Med. 1995;15(2):178–82.
• 18. Famini P, Maya MM, Melmed S (2011). “Pituitary magnetic resonance imaging for sellar and parasellar masses: ten-year experience in 2598 patients”. J Clin Endocrinol Metab. 2011: 96 (6): 1633–41.
• 19. Türkiye Endokrinoloji ve Metabolizma Derneği 2018 Somatotrof Adenom. Hipofiz Hastalıkları Tanı, Tedavi ve İzlem Kılavuzu. 2018:29-37.
• 20. Goyal P, Gupta A, Srivastava S, Modi S. Avoiding Complications in Endoscopic Trans-Sphenoidal Surgery for Pituitary Adenoma: A Beginner’s Perspective. Asian J Neurosurg. 2020;15(4):899–907.
• 21. Cıkla U, Binatlı AÖ, Demirçivi Özer F, Çiftçi E. Comparison of endoscopic and microsurgical techniques for transsphenoidal pituitary surgery. J Nervous Sys Surgery. 2010; 3(2):61-5.
• 22. Wang Q, Guo X, Gao L, Wang Z, Deng K, Lian W, et al. Surgical Outcome of Growth Hormone-Secreting Pituitary Adenoma with Empty Sella Using a New Classification. World Neurosurg. 2017;105:651–8.
• 23. Campero A, Villalonga JF, Basso A. Anatomical Risk Factors for Intraoperative Cerebrospinal Fluid Leaks During Transsphenoidal Surgery for Pituitary Adenomas. World Neurosurg. 2019; 1878-8750(18)32917-6. doi: 10.1016/j.wneu.2018.12.094
• 24. Shiley SG, Limonadi F, Delashaw JB, Barnwell SL, Andersen PE, Hwang PH, et al. Incidence, etiology, and management of cerebrospinal fluid leaks following trans-sphenoidal surgery. Laryngoscope. 2003 Aug;113(8):1283–8.
• 25. de Vries F, Lobatto DJ, Verstegen MJT, Schutte PJ, Notting IC, Kruit MC, et al. Outcome Squares integrating efficacy and safety, as applied to functioning pituitary adenoma surgery. J Clin Endocrinol Metab. 2021;106(9):e3300-e3311 26. Sommerfelt H, Sagberg LM, Solheim O. Impact of transsphenoidal surgery for pituitary adenomas on overall health-related quality of life: a longitudinal cohort study. Br J Neurosurg. 2019;33(6):635–40.
• 27. Baldia M, Rajaratnam S, Rajshekhar V. Postoperative Hormonal Outcomes in Patients with Large and Giant Non-functioning Pituitary Adenomas. Neurol India. 2020;68:106–12.
• 28. Shen M, Chen Z, Shou X, He W, Qiao N, Ma Z, et al. 2010 versus the 2000 consensus criteria in patients with normalised insulin-like growth factor 1 after transsphenoidal surgery has high predictive values for long-term recurrence-free survival in acromegaly. J Neuroendocrinol. 2021;33(5):e12958.
• 29. Kunigelis KE, Arnone G, Chatain G, Hoffman J, Chatain O, Coulter I, et al. Defining the timing and role of acute postoperative imaging in pituitary adenoma surgery: clinical study. Acta Neurochir (Wien). 2020;162(10):2353–60.