Tao Xie1, Tengfei Liu1, Xiaobiao Zhang2, Lingli Chen3, Rongkui Luo3, Wei Sun4, Fan Hu1, Yong Yu1, Ye Gu1, Zhiqiang Lu5. 1. Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China. 2. Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China; Digital Medical Research Center, Fudan University, Shanghai, China; Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, China. Electronic address: xiaobiao_zhang@163.com. 3. Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China. 4. Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China. 5. Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.
Abstract
OBJECTIVE: To investigate the role of endoscopic endonasal transsphenoidal surgery and the pseudocapsule in the treatment of growth hormone adenomas. METHODS: The study included 43 patients (age range, 21-64 years) with growth hormone adenomas treated with an endoscopic endonasal approach. We compared the tumor characteristics and surgical outcomes of cases with (group A, 21 cases, from November 2013 to January 2015) and without (group B, 22 cases, from October 2011 to October 2013) extra-pseudocapsule resection. RESULTS: The preoperative demographics, tumor characteristics, and surgical complications were not significantly different between groups A and B. Postoperative remission without adjuvant therapy was achieved in 18 of 21 cases (85.7%) in group A, which was significantly greater than that observed in group B (12 of 22 cases [54.4%]). In group A, the pseudocapsules were verified by endoscopy and histopathology. The pseudocapsule was removed en bloc with the whole adenoma in only 5 cases (23.8%). For the remaining 16 patients (76.2%), following extra-pseudocapsule dissection, incomplete pseudocapsule removals with intracapsule procedures were achieved. CONCLUSIONS: The combination of extra-pseudocapsule resection and endoscopy led to a high rate of gross total tumor resection and endocrinologicl remission in acromegalic patients compared with the group with intracapsular resection. Extra-pseudocapsule resection resulted in no additional postoperative complications.
OBJECTIVE: To investigate the role of endoscopic endonasal transsphenoidal surgery and the pseudocapsule in the treatment of growth hormoneadenomas. METHODS: The study included 43 patients (age range, 21-64 years) with growth hormoneadenomas treated with an endoscopic endonasal approach. We compared the tumor characteristics and surgical outcomes of cases with (group A, 21 cases, from November 2013 to January 2015) and without (group B, 22 cases, from October 2011 to October 2013) extra-pseudocapsule resection. RESULTS: The preoperative demographics, tumor characteristics, and surgical complications were not significantly different between groups A and B. Postoperative remission without adjuvant therapy was achieved in 18 of 21 cases (85.7%) in group A, which was significantly greater than that observed in group B (12 of 22 cases [54.4%]). In group A, the pseudocapsules were verified by endoscopy and histopathology. The pseudocapsule was removed en bloc with the whole adenoma in only 5 cases (23.8%). For the remaining 16 patients (76.2%), following extra-pseudocapsule dissection, incomplete pseudocapsule removals with intracapsule procedures were achieved. CONCLUSIONS: The combination of extra-pseudocapsule resection and endoscopy led to a high rate of gross total tumor resection and endocrinologicl remission in acromegalicpatients compared with the group with intracapsular resection. Extra-pseudocapsule resection resulted in no additional postoperative complications.
Authors: Emma M H Slot; Rengin Sabaoglu; Eduard H J Voormolen; Eelco W Hoving; Tristan P C van Doormaal Journal: J Neurol Surg B Skull Base Date: 2021-08-20