Joshua Bakhsheshian1, Sarah Wheeler2, Ben A Strickland1, Martin H Pham1, Robert C Rennert1, John Carmichael3, Martin Weiss1, Gabriel Zada1. 1. Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California. 2. Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California. 3. Division of Endo-crinology, Department of Medicine, Keck School of Medicine of USC, Los Angeles, California.
Abstract
BACKGROUND: Endonasal transsphenoidal surgery (ETSS) remains the preferred treatment for recurrent or residual nonfunctional pituitary adenomas (NFPAs). However, surgical complications and outcomes with repeat ETSS are unclear. OBJECTIVE: To compare outcomes from primary and repeat ETSS in patients with NFPAs. METHODS: Retrospective review of ETSS for NFPAs at USC University Hospital and LAC + USC Medical Center between 2000 and 2015. Patients with ≥3-mo follow-up data were included. Patients were categorized as primary or repeat ETSS. Patient and tumor characteristics were compared preoperatively, and postoperative outcomes were analyzed. RESULTS: Two hundred sixty-eight patients (89%) met the inclusion criteria (primary ETSS = 211 and repeat ETSS = 57) with a mean follow-up time of 38 mo (range 3-235 mo). Both groups had similar demographics, endocrine function, and tumor characteristics. Surgical complication rates were similar and no mortalities were observed. Repeat ETSS patients had a higher rate of new postoperative panhypopituitarism (primary ETSS: 0.5% vs repeat ETSS: 7.1%, P = .011), lower rates of gross total resection (GTR; primary ETSS: 59.2% vs repeat ETSS: 26.3%, P = .001), and greater rates of postoperative radiosurgery (36.8% vs 24.2%, P = .009). At 2-yr follow-up, progression-free survival on MRI was similar in both groups (primary ETSS: 97.9% vs repeat ETSS: 95.4%, log-rank test P = .807). CONCLUSION: At experienced tertiary pituitary centers, repeat ETSS for NFPAs was associated with a similar incidence of surgical complications as primary ETSS. However, repeat ETSS carried a higher rate for worsening endocrine dysfunction and a lower rate of GTR.
BACKGROUND: Endonasal transsphenoidal surgery (ETSS) remains the preferred treatment for recurrent or residual nonfunctional pituitary adenomas (NFPAs). However, surgical complications and outcomes with repeat ETSS are unclear. OBJECTIVE: To compare outcomes from primary and repeat ETSS in patients with NFPAs. METHODS: Retrospective review of ETSS for NFPAs at USC University Hospital and LAC + USC Medical Center between 2000 and 2015. Patients with ≥3-mo follow-up data were included. Patients were categorized as primary or repeat ETSS. Patient and tumor characteristics were compared preoperatively, and postoperative outcomes were analyzed. RESULTS: Two hundred sixty-eight patients (89%) met the inclusion criteria (primary ETSS = 211 and repeat ETSS = 57) with a mean follow-up time of 38 mo (range 3-235 mo). Both groups had similar demographics, endocrine function, and tumor characteristics. Surgical complication rates were similar and no mortalities were observed. Repeat ETSSpatients had a higher rate of new postoperative panhypopituitarism (primary ETSS: 0.5% vs repeat ETSS: 7.1%, P = .011), lower rates of gross total resection (GTR; primary ETSS: 59.2% vs repeat ETSS: 26.3%, P = .001), and greater rates of postoperative radiosurgery (36.8% vs 24.2%, P = .009). At 2-yr follow-up, progression-free survival on MRI was similar in both groups (primary ETSS: 97.9% vs repeat ETSS: 95.4%, log-rank test P = .807). CONCLUSION: At experienced tertiary pituitary centers, repeat ETSS for NFPAs was associated with a similar incidence of surgical complications as primary ETSS. However, repeat ETSS carried a higher rate for worsening endocrine dysfunction and a lower rate of GTR.
Authors: Stephanie E Baldeweg; Hani Joseph Marcus; Elika Karvandi; John Gerrard Hanrahan; Danyal Zaman Khan; Pierre-Marc Boloux; Fion Bremner; Ivan Cabrilo; Neil Dorward; Joan Grieve; Sue Jackson; Glenda Jimenez; Inma Serrano; Victoria Anne Nowak; Angelos Kolias Journal: Pituitary Date: 2022-07-15 Impact factor: 3.599
Authors: Megha K Sheth; Ben A Strickland; Lawrance K Chung; Robert G Briggs; Martin Weiss; Bozena Wrobel; Gabriel Zada Journal: J Neurosurg Case Lessons Date: 2022-06-20