Hussam Abou-Al-Shaar1, Arka N Mallela1, Aneek Patel1, Rimsha K Shariff2, Samuel S Shin3, Phillip A Choi4, Amir H Faraji5, Pouneh K Fazeli2, Tina Costacou6, Eric W Wang7, Juan C Fernandez-Miranda8, Carl H Snyderman7, Paul A Gardner1, Georgios A Zenonos9. 1. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 2. Neuroendocrinology Unit, Division of Endocrinology and Metabolism, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 3. Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA. 4. Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, TX, USA. 5. Department of Neurosurgery, Houston Methodist, Houston, TX, USA. 6. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA. 7. Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. 8. Department of Neurosurgery, Stanford University, Palo Alto, CA, USA. 9. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. zenonosg2@upmc.edu.
Abstract
PURPOSE: To review our institutional experience with the surgical management of prolactinomas through the endoscopic endonasal approach with specific focus on cavernous sinus invasion. METHODS: Clinical and radiographic data were collected retrospectively from the electronic medical record of 78 consecutive patients with prolactinomas undergoing endoscopic endonasal resection from 2002 to 2019. Immediate and late post-operative remission were defined as prolactin < 20 ng/mL within 14 days and 1-year of surgery without adjuvant therapy, respectively. Cavernous sinus invasion was quantified by Knosp score. RESULTS: A total of 78 patients with prolactinoma, 59% being male, underwent surgical resection with a mean age of 37 ± 13 years. Indications for surgery were medication resistance in 38 patients (48.7%), medication intolerance in 11 (14.1%), and patient preference in 29 (37.2%). Patients with Knosp 0-2 achieved higher immediate remission rates (83.8%) compared to patients with Knosp 3 (58.8%) and Knosp 4 (41.7%) patients (p = 0.003). Long-term remission rates were 48.7% and increased to 71.8% when combined with adjuvant treatments. Knosp 4 prolactinomas had significantly higher tumor volumes, higher preoperative prolactin levels, higher recurrence rates, higher rates of adjuvant therapy utilization, and were more likely to have failed dopamine agonist therapy compared to other tumor grades (p < 0.05). We encountered 18 complications in our series, and no cerebrospinal fluid leaks. CONCLUSION: The endoscopic endonasal approach is a safe and effective modality that can be employed in properly selected patients with invasive prolactinomas. It is associated with improved control and remission rates despite cavernous sinus invasion, though at a lower rate than without invasion.
PURPOSE: To review our institutional experience with the surgical management of prolactinomas through the endoscopic endonasal approach with specific focus on cavernous sinus invasion. METHODS: Clinical and radiographic data were collected retrospectively from the electronic medical record of 78 consecutive patients with prolactinomas undergoing endoscopic endonasal resection from 2002 to 2019. Immediate and late post-operative remission were defined as prolactin < 20 ng/mL within 14 days and 1-year of surgery without adjuvant therapy, respectively. Cavernous sinus invasion was quantified by Knosp score. RESULTS: A total of 78 patients with prolactinoma, 59% being male, underwent surgical resection with a mean age of 37 ± 13 years. Indications for surgery were medication resistance in 38 patients (48.7%), medication intolerance in 11 (14.1%), and patient preference in 29 (37.2%). Patients with Knosp 0-2 achieved higher immediate remission rates (83.8%) compared to patients with Knosp 3 (58.8%) and Knosp 4 (41.7%) patients (p = 0.003). Long-term remission rates were 48.7% and increased to 71.8% when combined with adjuvant treatments. Knosp 4 prolactinomas had significantly higher tumor volumes, higher preoperative prolactin levels, higher recurrence rates, higher rates of adjuvant therapy utilization, and were more likely to have failed dopamine agonist therapy compared to other tumor grades (p < 0.05). We encountered 18 complications in our series, and no cerebrospinal fluid leaks. CONCLUSION: The endoscopic endonasal approach is a safe and effective modality that can be employed in properly selected patients with invasive prolactinomas. It is associated with improved control and remission rates despite cavernous sinus invasion, though at a lower rate than without invasion.
Authors: J Verhelst; R Abs; D Maiter; A van den Bruel; M Vandeweghe; B Velkeniers; J Mockel; G Lamberigts; P Petrossians; P Coremans; C Mahler; A Stevenaert; J Verlooy; C Raftopoulos; A Beckers Journal: J Clin Endocrinol Metab Date: 1999-07 Impact factor: 5.958
Authors: A Colao; A Di Sarno; M L Landi; S Cirillo; F Sarnacchiaro; G Facciolli; R Pivonello; M Cataldi; B Merola; L Annunziato; G Lombardi Journal: J Clin Endocrinol Metab Date: 1997-11 Impact factor: 5.958