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Erschienen in: Endocrine 3/2022

13.08.2022 | Original Article

Effect of pituitary adenoma consistency on surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal surgery

verfasst von: A. Acitores Cancela, V. Rodríguez Berrocal, H. Pian Arias, J. J. Díez, P. Iglesias

Erschienen in: Endocrine | Ausgabe 3/2022

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Abstract

Background

Most pituitary adenomas (PAs) are considered to have a soft tumor consistency. However, there is a non-negligible percentage (5–13%) of tumors presenting or exhibiting a fibrous consistency that would entail a more difficult and complicated surgical excision with higher surgical morbidity and mortality rates.

Purpose

To analyze the clinical consequences of PA tumor consistency on the surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal (EET) pituitary surgery.

Methods

An ambispective study of patients with PAs operated on through an EET approach in two Spanish tertiary hospitals over the last 12 years. A total of 226 consecutive interventions were carried out in the Neurosurgery Departments of the Hospital Universitario Ramón y Cajal (HURC) and the Hospital Universitario Puerta del Sur by the same neurosurgeon. PAs were grouped into soft (n = 150) and fibrous (n = 76). All patients underwent hormonal and magnetic resonance imaging (MRI) studies before and after surgery. In addition, neurosurgical complications were recorded in each patient.

Results

Fibrous adenomas were independently associated with lower resection rates compared to soft adenomas (fibrous gross total resection [GTR] rate 48.7% vs. 76.3%, p < 0.001), even in those adenomas without invasion of the cavernous sinus (Knosp grades 0, I, and II). There were more intraoperative cerebrospinal fluid (CSF) leaks in patients with fibrous PAs. Moreover, fibrous PAs showed higher rates of postoperative hypopituitarism, permanent diabetes insipidus (DI) and postoperative treatments (hormonal treatment and radiotherapy). The excision of a fibrous PA required a longer surgical time (22.5 min more than soft PAs, p = 0.014), regardless of other factors.

Conclusion

The consistency of the PAs significantly conditions both the results of surgery (lower resections rates), complications (higher incidence of postoperative hypopituitarism, permanent DI), and the prognosis (higher incidence of postoperative treatments) of the patient undergoing EET.
Literatur
1.
Zurück zum Zitat Q.T. Ostrom et al. CBTRUS Statistical Report: primary brain and other central nervous system tumors diagnosed in the United States in 2012–2016. Neuro. Oncol. 21(5), v1–v100 (2019) PubMedPubMedCentralCrossRef Q.T. Ostrom et al. CBTRUS Statistical Report: primary brain and other central nervous system tumors diagnosed in the United States in 2012–2016. Neuro. Oncol. 21(5), v1–v100 (2019) PubMedPubMedCentralCrossRef
2.
Zurück zum Zitat M. Cappelletti, A.G. Ruggeri, L. Spizzichino, A. D’Amico, E. D’avella, R. Delfini, Fibrous pituitary macroadenomas: predictive role of preoperative radiologic investigations for proper surgical planning in a cohort of 66 patients. World Neurosurg. 121(Jan), e449–e457 (2019) PubMedCrossRef M. Cappelletti, A.G. Ruggeri, L. Spizzichino, A. D’Amico, E. D’avella, R. Delfini, Fibrous pituitary macroadenomas: predictive role of preoperative radiologic investigations for proper surgical planning in a cohort of 66 patients. World Neurosurg. 121(Jan), e449–e457 (2019) PubMedCrossRef
3.
Zurück zum Zitat L. Yiping, X. Ji, G. Daoying, Y. Bo, Prediction of the consistency of pituitary adenoma: a comparative study on diffusion-weighted imaging and pathological results. J. Neuroradiol. 43(3 Jun), 186–194 (2016) PubMedCrossRef L. Yiping, X. Ji, G. Daoying, Y. Bo, Prediction of the consistency of pituitary adenoma: a comparative study on diffusion-weighted imaging and pathological results. J. Neuroradiol. 43(3 Jun), 186–194 (2016) PubMedCrossRef
4.
Zurück zum Zitat J.W. Rutland et al. Analysis of 7-tesla diffusion-weighted imaging in the prediction of pituitary macroadenoma consistency. J. Neurosurg. 134(3), 771–779 (2021) CrossRef J.W. Rutland et al. Analysis of 7-tesla diffusion-weighted imaging in the prediction of pituitary macroadenoma consistency. J. Neurosurg. 134(3), 771–779 (2021) CrossRef
5.
Zurück zum Zitat M.E. Molitch, Diagnosis and treatment of pituitary adenomas: a review. JAMA - J. Am. Med. Assoc. 317(5), 516–524 (2017) CrossRef M.E. Molitch, Diagnosis and treatment of pituitary adenomas: a review. JAMA - J. Am. Med. Assoc. 317(5), 516–524 (2017) CrossRef
6.
Zurück zum Zitat S. Schur, O. Lasry, M.A. Tewfik & S. Di Maio, Assessing the association of tumor consistency and gland manipulation on hormonal outcomes and delayed hyponatremia in pituitary macroadenoma surgery. Interdiscip. Neurosurg. Adv. Tech. Case Manag., 20, no. November, 2020 S. Schur, O. Lasry, M.A. Tewfik & S. Di Maio, Assessing the association of tumor consistency and gland manipulation on hormonal outcomes and delayed hyponatremia in pituitary macroadenoma surgery. Interdiscip. Neurosurg. Adv. Tech. Case Manag., 20, no. November, 2020
7.
Zurück zum Zitat M.J. Rutkowski et al. Development and clinical validation of a grading system for pituitary adenoma consistency. J. Neurosurg. 134(6), 1800–1807 (2021) CrossRef M.J. Rutkowski et al. Development and clinical validation of a grading system for pituitary adenoma consistency. J. Neurosurg. 134(6), 1800–1807 (2021) CrossRef
8.
Zurück zum Zitat E. Knosp, E. Steiner, K. Kitz, C. Matula, Pituitary adenomas with invasion of the cavernous sinus space. Neurosurgery 33(4 Oct), 610–618 (1993) PubMed E. Knosp, E. Steiner, K. Kitz, C. Matula, Pituitary adenomas with invasion of the cavernous sinus space. Neurosurgery 33(4 Oct), 610–618 (1993) PubMed
9.
Zurück zum Zitat J.C. Fernandez-Miranda et al. Cavernous sinus compartments from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery. J. Neurosurg. 129(2), 430–441 (2018) PubMedCrossRef J.C. Fernandez-Miranda et al. Cavernous sinus compartments from the endoscopic endonasal approach: anatomical considerations and surgical relevance to adenoma surgery. J. Neurosurg. 129(2), 430–441 (2018) PubMedCrossRef
10.
Zurück zum Zitat A.E. Ortiz-Flores et al. Role of sampling times and serum cortisol cut-off concentrations on the routine assessment of adrenal function using the standard cosyntropin test in an academic hospital from Spain: a retrospective chart review. BMJ Open 8(5), 1–10 (2018) CrossRef A.E. Ortiz-Flores et al. Role of sampling times and serum cortisol cut-off concentrations on the routine assessment of adrenal function using the standard cosyntropin test in an academic hospital from Spain: a retrospective chart review. BMJ Open 8(5), 1–10 (2018) CrossRef
11.
Zurück zum Zitat L. Katznelson et al. Acromegaly: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 99(11), 3933–3951 (2014) PubMedCrossRef L. Katznelson et al. Acromegaly: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 99(11), 3933–3951 (2014) PubMedCrossRef
12.
Zurück zum Zitat L.K. Nieman et al. The diagnosis of Cushing’s syndrome: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 93(5), 1526–1540 (2008) PubMedPubMedCentralCrossRef L.K. Nieman et al. The diagnosis of Cushing’s syndrome: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 93(5), 1526–1540 (2008) PubMedPubMedCentralCrossRef
13.
Zurück zum Zitat P. Beck-Peccoz, A. Lania, A. Beckers, K. Chatterjee, J.-L. Wemeau, 2013 European thyroid association guidelines for the diagnosis and treatment of thyrotropin-secreting pituitary tumors. Eur. Thyroid J. 2(2), 76–82 (2013) PubMedPubMedCentralCrossRef P. Beck-Peccoz, A. Lania, A. Beckers, K. Chatterjee, J.-L. Wemeau, 2013 European thyroid association guidelines for the diagnosis and treatment of thyrotropin-secreting pituitary tumors. Eur. Thyroid J. 2(2), 76–82 (2013) PubMedPubMedCentralCrossRef
14.
Zurück zum Zitat S. Melmed et al. Diagnosis and treatment of hyperprolactinemia: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 96(2), 273–288 (2011) PubMedCrossRef S. Melmed et al. Diagnosis and treatment of hyperprolactinemia: an endocrine society clinical practice guideline. J. Clin. Endocrinol. Metab. 96(2), 273–288 (2011) PubMedCrossRef
15.
Zurück zum Zitat M. Araujo-Castro et al. Postoperative management of patients with pituitary tumors submitted to pituitary surgery. Experience of a Spanish Pituitary Tumor Center of Excellence. Endocrine 69(1), 5–17 (2020) PubMedCrossRef M. Araujo-Castro et al. Postoperative management of patients with pituitary tumors submitted to pituitary surgery. Experience of a Spanish Pituitary Tumor Center of Excellence. Endocrine 69(1), 5–17 (2020) PubMedCrossRef
16.
Zurück zum Zitat A.L. Pappy, A. Savinkina, C. Bicknese, S. Neill, N.M. Oyesiku, A.G. Ioachimescu, Predictive modeling for pituitary adenomas: single center experience in 501 consecutive patients. Pituitary 22(5), 520–531 (2019) PubMedCrossRef A.L. Pappy, A. Savinkina, C. Bicknese, S. Neill, N.M. Oyesiku, A.G. Ioachimescu, Predictive modeling for pituitary adenomas: single center experience in 501 consecutive patients. Pituitary 22(5), 520–531 (2019) PubMedCrossRef
17.
Zurück zum Zitat A.O. Asemota, M. Ishii, H. Brem, G.L. Gallia, Comparison of complications, trends, and costs in endoscopic vs microscopic pituitary surgery: analysis from a US health claims database. Clin. Neurosurg. 81(3), 458–471 (2017) CrossRef A.O. Asemota, M. Ishii, H. Brem, G.L. Gallia, Comparison of complications, trends, and costs in endoscopic vs microscopic pituitary surgery: analysis from a US health claims database. Clin. Neurosurg. 81(3), 458–471 (2017) CrossRef
18.
Zurück zum Zitat L. Lv et al. Clinical and pathologic characteristics predicted the postoperative recurrence and progression of pituitary adenoma: a retrospective study with 10 years follow-up. World Neurosurg. 118(Oct), e428–e435 (2018) PubMedCrossRef L. Lv et al. Clinical and pathologic characteristics predicted the postoperative recurrence and progression of pituitary adenoma: a retrospective study with 10 years follow-up. World Neurosurg. 118(Oct), e428–e435 (2018) PubMedCrossRef
19.
Zurück zum Zitat S. Dhandapani, H. Singh, H.M. Negm, S. Cohen, V.K. Anand, T.H. Schwartz, Cavernous sinus invasion in pituitary adenomas: systematic review and pooled data meta-analysis of radiologic criteria and comparison of endoscopic and microscopic surgery. World Neurosurg. 96, 36–46 (2016) PubMedCrossRef S. Dhandapani, H. Singh, H.M. Negm, S. Cohen, V.K. Anand, T.H. Schwartz, Cavernous sinus invasion in pituitary adenomas: systematic review and pooled data meta-analysis of radiologic criteria and comparison of endoscopic and microscopic surgery. World Neurosurg. 96, 36–46 (2016) PubMedCrossRef
20.
Zurück zum Zitat M.A. Mooney et al. Proposal and validation of a simple grading scale (TRANSSPHER Grade) for predicting gross total resection of nonfunctioning pituitary macroadenomas after transsphenoidal surgery. Oper. Neurosurg. 17(5), 460–469 (2019) CrossRef M.A. Mooney et al. Proposal and validation of a simple grading scale (TRANSSPHER Grade) for predicting gross total resection of nonfunctioning pituitary macroadenomas after transsphenoidal surgery. Oper. Neurosurg. 17(5), 460–469 (2019) CrossRef
21.
Zurück zum Zitat T. Ouyang et al. Outcomes and Complications of Aggressive Resection Strategy for Pituitary Adenomas in Knosp Grade 4 With Transsphenoidal Endoscopy. Front. Oncol. 11, 1–12 (2021) CrossRef T. Ouyang et al. Outcomes and Complications of Aggressive Resection Strategy for Pituitary Adenomas in Knosp Grade 4 With Transsphenoidal Endoscopy. Front. Oncol. 11, 1–12 (2021) CrossRef
22.
Zurück zum Zitat A. Acitores Cancela, V. Rodríguez Berrocal, H. Pian, J.S. Martínez San Millán, J.J. Díez, P. Iglesias,, Clinical relevance of tumor consistency in pituitary adenoma. Hormones 20(3), 463–473 (2021). PubMedCrossRef A. Acitores Cancela, V. Rodríguez Berrocal, H. Pian, J.S. Martínez San Millán, J.J. Díez, P. Iglesias,, Clinical relevance of tumor consistency in pituitary adenoma. Hormones 20(3), 463–473 (2021). PubMedCrossRef
23.
Zurück zum Zitat X. Y. Chen et al. Relationship between pituitary adenoma consistency and extent of resection based on tumor/cerebellar peduncle T2-weighted imaging intensity (TCTI) ratio of the point on preoperative magnetic resonance imaging (MRI) corresponding to the residual point on Postoperative MRI. Med. Sci. Monit. 26, 1–8 (2020) X. Y. Chen et al. Relationship between pituitary adenoma consistency and extent of resection based on tumor/cerebellar peduncle T2-weighted imaging intensity (TCTI) ratio of the point on preoperative magnetic resonance imaging (MRI) corresponding to the residual point on Postoperative MRI. Med. Sci. Monit. 26, 1–8 (2020)
24.
Zurück zum Zitat W.A. Azab et al. Endoscopic endonasal excision of large and giant pituitary adenomas: radiological and intraoperative correlates of the extent of resection. World Neurosurg. 126, e793–e802 (2019) PubMedCrossRef W.A. Azab et al. Endoscopic endonasal excision of large and giant pituitary adenomas: radiological and intraoperative correlates of the extent of resection. World Neurosurg. 126, e793–e802 (2019) PubMedCrossRef
25.
Zurück zum Zitat A.K. Thotakura, M.R. Patibandla, M.K. Panigrahi, A. Mahadevan, Is it really possible to predict the consistency of a pituitary adenoma preoperatively? Neurochirurgie 63, 453–457 (2017) PubMedCrossRef A.K. Thotakura, M.R. Patibandla, M.K. Panigrahi, A. Mahadevan, Is it really possible to predict the consistency of a pituitary adenoma preoperatively? Neurochirurgie 63, 453–457 (2017) PubMedCrossRef
26.
Zurück zum Zitat A. Micko et al. Challenging Knosp high-grade pituitary adenomas. J. Neurosurg. 132, 1739–1746 (2020). CrossRef A. Micko et al. Challenging Knosp high-grade pituitary adenomas. J. Neurosurg. 132, 1739–1746 (2020). CrossRef
27.
Zurück zum Zitat S. Yamada et al. Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases. J. Neurosurg. 121(6 Dec), 1462–1473 (2014) PubMedCrossRef S. Yamada et al. Clinicopathological characteristics and therapeutic outcomes in thyrotropin-secreting pituitary adenomas: a single-center study of 90 cases. J. Neurosurg. 121(6 Dec), 1462–1473 (2014) PubMedCrossRef
28.
Zurück zum Zitat J.A. Gondim, J.P.C. Almeida, L.A.F. Albuquerque, E.F. Gomes, M. Schops, Giant pituitary adenomas: surgical outcomes of 50 cases operated on by the endonasal endoscopic approach. World Neurosurg. 82(1–2), e281–e290 (2014) PubMedCrossRef J.A. Gondim, J.P.C. Almeida, L.A.F. Albuquerque, E.F. Gomes, M. Schops, Giant pituitary adenomas: surgical outcomes of 50 cases operated on by the endonasal endoscopic approach. World Neurosurg. 82(1–2), e281–e290 (2014) PubMedCrossRef
29.
Zurück zum Zitat A.S. Little et al. Evaluation of surgical resection goal and its relationship to extent of resection and patient outcomes in a multicenter prospective study of patients with surgically treated, nonfunctioning pituitary adenomas: a case series. Oper. Neurosurg. 18(1), 26–33 (2020) CrossRef A.S. Little et al. Evaluation of surgical resection goal and its relationship to extent of resection and patient outcomes in a multicenter prospective study of patients with surgically treated, nonfunctioning pituitary adenomas: a case series. Oper. Neurosurg. 18(1), 26–33 (2020) CrossRef
30.
Zurück zum Zitat M. Araujo-Castro et al. Predictive model of surgical remission in acromegaly: age, presurgical GH levels and Knosp grade as the best predictors of surgical remission. J. Endocrinol. Invest. 44(1), 183–193 (2021) PubMedCrossRef M. Araujo-Castro et al. Predictive model of surgical remission in acromegaly: age, presurgical GH levels and Knosp grade as the best predictors of surgical remission. J. Endocrinol. Invest. 44(1), 183–193 (2021) PubMedCrossRef
31.
Zurück zum Zitat R.D. Almutairi et al. Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery: a meta-analysis. Acta Neurochir. (Wien.) 160(5 May), 1005–1021 (2018) CrossRef R.D. Almutairi et al. Gross total resection of pituitary adenomas after endoscopic vs. microscopic transsphenoidal surgery: a meta-analysis. Acta Neurochir. (Wien.) 160(5 May), 1005–1021 (2018) CrossRef
32.
Zurück zum Zitat X. Bao et al. Extended transsphenoidal approach for pituitary adenomas invading the cavernous sinus using multiple complementary techniques. Pituitary 19(1), 1–10 (2016) PubMedCrossRef X. Bao et al. Extended transsphenoidal approach for pituitary adenomas invading the cavernous sinus using multiple complementary techniques. Pituitary 19(1), 1–10 (2016) PubMedCrossRef
33.
Zurück zum Zitat G. Alzhrani, W. Sivakumar, M.S. Park, P. Taussky, W.T. Couldwell, Delayed complications after transsphenoidal surgery for pituitary adenomas. World Neurosurg. 109(Jan), 233–241 (2018) PubMedCrossRef G. Alzhrani, W. Sivakumar, M.S. Park, P. Taussky, W.T. Couldwell, Delayed complications after transsphenoidal surgery for pituitary adenomas. World Neurosurg. 109(Jan), 233–241 (2018) PubMedCrossRef
34.
Zurück zum Zitat T.H. Schwartz, A role for centers of excellence in transsphenoidal surgery. World Neurosurg. 80(3–4), 270–271 (2013) PubMedCrossRef T.H. Schwartz, A role for centers of excellence in transsphenoidal surgery. World Neurosurg. 80(3–4), 270–271 (2013) PubMedCrossRef
35.
Zurück zum Zitat M.S. Agam, M.A. Wedemeyer, B. Wrobel, M.H. Weiss, J.D. Carmichael, G. Zada, Complications associated with microscopic and endoscopic transsphenoidal pituitary surgery: experience of 1153 consecutive cases treated at a single tertiary care pituitary center. J. Neurosurg. 130(5), 1576–1583 (2019) CrossRef M.S. Agam, M.A. Wedemeyer, B. Wrobel, M.H. Weiss, J.D. Carmichael, G. Zada, Complications associated with microscopic and endoscopic transsphenoidal pituitary surgery: experience of 1153 consecutive cases treated at a single tertiary care pituitary center. J. Neurosurg. 130(5), 1576–1583 (2019) CrossRef
36.
Zurück zum Zitat S.H. Kim et al. Immediate postoperative measurement of thyroid-stimulating hormone as an early predictor of remission in thyroid-stimulating hormone–secreting pituitary adenomas. J. Neurosurg., pp. 1–7, 2020 S.H. Kim et al. Immediate postoperative measurement of thyroid-stimulating hormone as an early predictor of remission in thyroid-stimulating hormone–secreting pituitary adenomas. J. Neurosurg., pp. 1–7, 2020
37.
Zurück zum Zitat D.J. Lobatto et al. Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review. Pituitary 21(1), 84–97 (2018) PubMedCrossRef D.J. Lobatto et al. Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review. Pituitary 21(1), 84–97 (2018) PubMedCrossRef
38.
Zurück zum Zitat N. Fatemi et al. Pituitary hormonal loss and recovery after transsphenoidal adenoma removal. Neurosurgery 63(4), 709–718 (2008) PubMedCrossRef N. Fatemi et al. Pituitary hormonal loss and recovery after transsphenoidal adenoma removal. Neurosurgery 63(4), 709–718 (2008) PubMedCrossRef
39.
Zurück zum Zitat A. Campero, J.F. Villalonga, A. Basso, Anatomical risk factors for intraoperative cerebrospinal fluid leaks during transsphenoidal surgery for pituitary adenomas. World Neurosurg. 124, e346–e355 (2019) CrossRef A. Campero, J.F. Villalonga, A. Basso, Anatomical risk factors for intraoperative cerebrospinal fluid leaks during transsphenoidal surgery for pituitary adenomas. World Neurosurg. 124, e346–e355 (2019) CrossRef
40.
Zurück zum Zitat M. Araujo-Castro, F. Mariño-Sánchez, A. Acitores Cancela, A. García Fernández, S. García Duque, V. Rodríguez Berrocal, Is it possible to predict the development of diabetes insipidus after pituitary surgery? Study of 241 endoscopic transsphenoidal pituitary surgeries. J. Endocrinol. Invest. 44, 1457–1464 (2021) PubMedCrossRef M. Araujo-Castro, F. Mariño-Sánchez, A. Acitores Cancela, A. García Fernández, S. García Duque, V. Rodríguez Berrocal, Is it possible to predict the development of diabetes insipidus after pituitary surgery? Study of 241 endoscopic transsphenoidal pituitary surgeries. J. Endocrinol. Invest. 44, 1457–1464 (2021) PubMedCrossRef
41.
Zurück zum Zitat W.T. Burke, D.J. Cote, D.L. Penn, S. Iuliano, K. McMillen, E.R. Laws, Diabetes Insipidus after endoscopic transsphenoidal surgery. Neurosurgery 87(5), 949–955 (2020) PubMedCrossRef W.T. Burke, D.J. Cote, D.L. Penn, S. Iuliano, K. McMillen, E.R. Laws, Diabetes Insipidus after endoscopic transsphenoidal surgery. Neurosurgery 87(5), 949–955 (2020) PubMedCrossRef
42.
Zurück zum Zitat P. Nayak, A.S. Montaser, J. Hu, D.M. Prevedello, L.S. Kirschner, L. Ghalib, Predictors of postoperative diabetes insipidus following endoscopic resection of pituitary adenomas. J. Endocr. Soc. 2(9), 1010–1019 (2018) PubMedPubMedCentralCrossRef P. Nayak, A.S. Montaser, J. Hu, D.M. Prevedello, L.S. Kirschner, L. Ghalib, Predictors of postoperative diabetes insipidus following endoscopic resection of pituitary adenomas. J. Endocr. Soc. 2(9), 1010–1019 (2018) PubMedPubMedCentralCrossRef
43.
Zurück zum Zitat E. Uvelius, P. Siesjö, 3-D endoscopy in surgery of pituitary adenomas, prospective evaluation of patient gain using basic outcome parameters. J. Clin. Neurosci. 76, 166–170 (2020) PubMedCrossRef E. Uvelius, P. Siesjö, 3-D endoscopy in surgery of pituitary adenomas, prospective evaluation of patient gain using basic outcome parameters. J. Clin. Neurosci. 76, 166–170 (2020) PubMedCrossRef
44.
Zurück zum Zitat P. Leach, A.H. Abou-Zeid, T. Kearney, J. Davis, P.J. Trainer, K.K. Gnanalingham, Endoscopic transsphenoidal pituitary surgery: evidence of an operative learning curve. Neurosurgery 67(5), 1205–1212 (2010) PubMedCrossRef P. Leach, A.H. Abou-Zeid, T. Kearney, J. Davis, P.J. Trainer, K.K. Gnanalingham, Endoscopic transsphenoidal pituitary surgery: evidence of an operative learning curve. Neurosurgery 67(5), 1205–1212 (2010) PubMedCrossRef
45.
Zurück zum Zitat H. Cheng et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J. Surg. Res. 229, 134–144 (2018) PubMedCrossRef H. Cheng et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J. Surg. Res. 229, 134–144 (2018) PubMedCrossRef
46.
Zurück zum Zitat J. Cyprich et al. Comparative preoperative characteristics and postoperative outcomes at a private versus a safety-net hospital following endoscopic endonasal transsphenoidal resection of pituitary adenomas. J. Neurosurg 134, 742–749 (2021) CrossRef J. Cyprich et al. Comparative preoperative characteristics and postoperative outcomes at a private versus a safety-net hospital following endoscopic endonasal transsphenoidal resection of pituitary adenomas. J. Neurosurg 134, 742–749 (2021) CrossRef
47.
Zurück zum Zitat A. Thotakura, M. Patibandla, M. Panigrahi, G. Addagada, Predictors of visual outcome with transsphenoidal excision of pituitary adenomas. Asian J. Neurosurg. 12(1), 1 (2017) PubMedPubMedCentralCrossRef A. Thotakura, M. Patibandla, M. Panigrahi, G. Addagada, Predictors of visual outcome with transsphenoidal excision of pituitary adenomas. Asian J. Neurosurg. 12(1), 1 (2017) PubMedPubMedCentralCrossRef
48.
Zurück zum Zitat R.W. Ho, H.M. Huang, J.T. Ho, The influence of pituitary adenoma size on vision and visual outcomes after trans-sphenoidal adenectomy: a report of 78 cases. J. Korean Neurosurg. Soc. 57(1), 23–31 (2015) PubMedPubMedCentralCrossRef R.W. Ho, H.M. Huang, J.T. Ho, The influence of pituitary adenoma size on vision and visual outcomes after trans-sphenoidal adenectomy: a report of 78 cases. J. Korean Neurosurg. Soc. 57(1), 23–31 (2015) PubMedPubMedCentralCrossRef
49.
Zurück zum Zitat C. Thomé, D. Zevgaridis, Delayed visual deterioration after pituitary surgery - A review introducing the concept of vascular compression of the optic pathways. Acta Neurochir. (Wien.) 146(10), 1131–1135 (2004) CrossRef C. Thomé, D. Zevgaridis, Delayed visual deterioration after pituitary surgery - A review introducing the concept of vascular compression of the optic pathways. Acta Neurochir. (Wien.) 146(10), 1131–1135 (2004) CrossRef
50.
Zurück zum Zitat H. Do et al. Extent of resection, visual, and endocrinologic outcomes for endoscopic endonasal surgery for recurrent pituitary adenomas. World Neurosurg. 102, 35–41 (2017) PubMedCrossRef H. Do et al. Extent of resection, visual, and endocrinologic outcomes for endoscopic endonasal surgery for recurrent pituitary adenomas. World Neurosurg. 102, 35–41 (2017) PubMedCrossRef
Metadaten
Titel
Effect of pituitary adenoma consistency on surgical outcomes in patients undergoing endonasal endoscopic transsphenoidal surgery
verfasst von
A. Acitores Cancela
V. Rodríguez Berrocal
H. Pian Arias
J. J. Díez
P. Iglesias
Publikationsdatum
13.08.2022
Verlag
Springer US
Erschienen in
Endocrine / Ausgabe 3/2022
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-022-03161-1

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