Nonfunctioning Pituitary Adenomas Are Really Clinically Nonfunctioning? Clinical and Endocrinological Symptoms and Outcomes with Endoscopic Endonasal Treatment

Yıldırım, Ali Erdem; Şahinoğlu, Mert; Ekici, Ibrahim; Cagil, Emin; Karaoğlu, Derya; Çelik, Haydar; Nacar, Osman Arikan; Belen, Ahmet Deniz

doi:10.1016/j.wneu.2015.08.073

Cited by 27 publications

(22 citation statements)

References 28 publications

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“…Eventually, 19 studies were included in the final analysis, enrolling 389 patients underwent microscopic transsphenoidal resection and 3458 patients with endoscopic approach. Four of which directly compared endoscopic and microscopic approaches [7][8][9][10], while the other 15 articles are single-armed studies [11][12][13][14][15][16][17][18][19][20][21][22][23], reporting purely endoscopic or microscopic transsphenoidal surgery on NFPA [11][12][13][14][15][16][17][18][20][21][22][23]. The proportion of gender, the presence of pre-operatively hypopituitarism, visual deficiency and invasive tumours were significant different between the two groups ( Table 1).…”

Section: Resultsmentioning

confidence: 99%

Outcomes of endoscopic and microscopic transsphenoidal surgery on non‐functioning pituitary adenomas: a systematic review and meta‐analysis

Yao

et al. 2018

J Cellular Molecular Medi

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Both microscopic and endoscopic transsphenoidal surgery are effective approaches for nonfunctioning pituitary adenomas. The issue on the comparison of their efficacy and safety remains inconsistent. A thorough search of the literatures (PubMed, EMBASE, MEDLINE) were performed up to March 2017. Studies reporting outcomes of microscopic or endoscopic transsphenoidal surgery on nonfunctioning pituitary adenomas were included. A meta‐analysis was performed focusing on the early stage and long term outcomes. The final search yielded 19 eligible studies enrolling 3847 patients, 389 of them underwent microscopic approach and 3458 of them with endoscopic approach. As to the early stage outcomes, the rate of gross tumor resection was significantly higher in the endoscopic group than that in microscopic group (73% versus 60%, P < 0.001). Meanwhile, endoscopic approach showed priority over microscopy on postoperative hypopituitarism (63% versus 65%, P < 0.001) and CSF leakage (3% versus 7%, P < 0.001). For the long term outcomes, the rate of visual improvement was significant higher in the endoscopic group than that in microscopic group (77% versus 50%, P < 0.001). However, there was no significant difference between the groups regarding the rate of permanent diabetic insipidus and meningitis. The endoscopic approach may be associated with higher rate of gross tumor movement and lower risk of postoperatively complications for treating nonfunctioning pituitary adenoma, when compared with microscopic approach. However, the confidence was shorted due to limited high quality evidence (largely randomized and controlled studies).

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Section: Resultsmentioning

confidence: 99%

Outcomes of endoscopic and microscopic transsphenoidal surgery on non‐functioning pituitary adenomas: a systematic review and meta‐analysis

Yao

et al. 2018

J Cellular Molecular Medi

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“…Mean age per study ranged between 35.5 and 72.5 years (median: 50) and the percentage female patients ranged between 15 and 100% (median: 45%). Seven studies included only non-functioning pituitary adenoma patients [ 28 , 31 , 33 , 37 , 40 , 42 , 46 ]. Gross total resection grades were reported in 26 studies and ranged between 14 and 91% (median: 63.5%) (Table 1 ) [ 5 , 6 , 8 , 11 , 20 , 21 , 24 – 26 , 28 – 34 , 36 – 40 , 42 , 43 , 46 , 47 ].…”

Section: Resultsmentioning

confidence: 99%

“…Patients presented with visual acuity complaints in 14–84% of cases (Supplementary Table 3) [ 5 , 36 ]. Ten studies evaluated postoperative visual acuity in their case series [ 5 , 6 , 9 , 20 , 22 , 25 , 30 , 36 , 37 , 46 ]. Pooled prevalence of overall improvement was 67.5% (95% CI: 59.1–75.0%, I 2 : 86.0%, n = 163/219).…”

Section: Resultsmentioning

confidence: 99%

“…Pooled prevalence of deterioration was 4.5% (95% CI: 1.8–10.8%, I 2 : 0.00%, n = 3/122) (Table 2 ). One study reported complete recovery of visual acuity in 9 out of 33 patients [ 46 ]. No significant publication bias was identified.…”

Section: Resultsmentioning

confidence: 99%

“…Patients presented with visual field deficits in 28–100% of cases (Supplementary Table 3) [ 5 , 41 , 42 ]. Nineteen studies described outcomes of visual field deficits [ 5 , 8 – 11 , 19 – 23 , 27 – 29 , 36 , 37 , 41 , 42 , 44 , 46 ]. The overall prevalence was 40.4% (95% CI: 34.8–46.3%, I 2 : 0.00%, n = 122/346) for complete recovery, 80.8% (95% CI: 77.7–83.6%, I 2 : 62.3%, n = 678/817) for overall improvement, and 2.3% (95% CI: 1.1–4.7%, I 2 : 0.00%, n = 3/398) for deterioration in which patients showed a decreased visual functioning postoperatively (Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

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Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis

et al. 2017

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PurposePatients with pituitary adenomas often present with visual deficits. While the aim of endoscopic endonasal transsphenoidal surgery (EETS) is to improve these deficits, permanent worsening is a possible outcome. The aim of this meta-analysis was to evaluate the effect of EETS for pituitary adenomas on visual outcomes.MethodsA meta-analysis was conducted according to the PRISMA guidelines. Pooled prevalence was calculated for complete recovery, improvement, and deterioration of visual field deficits, visual acuity and unspecified visual function in fixed- and random-effect models, including assessment of heterogeneity (I2) and publication bias (Begg’s test).ResultsOut of 2636 articles, 35 case series were included in the meta-analysis. Results are described for fixed-effect models. For patients with impaired visual acuity, only one study reported complete recovery (27.2%). Pooled prevalence for improvement was 67.5% (95% CI = 59.1–75.0%), but with considerable heterogeneity (I2: 86.0%), and 4.50% (95% CI = 1.80–10.8%) for patients experiencing deterioration. For patients with visual field deficits, the prevalence was 40.4% (95% CI = 34.8–46.3%) for complete recovery, 80.8% (95% CI = 77.7–83.6%) for improvement, and 2.3% (95% CI = 1.1–4.7%) for deterioration. For the unspecified visual outcomes, pooled prevalence of complete recovery was 32.9% (95% CI: 28.5–37.7%), but with considerable heterogeneity (I2 = 84.2%). The prevalence was 80.9% (95% CI = 77.9–83.6) for improvement and 2.00% (95% CI = 1.10–3.40%) for deterioration. Random-effect models yielded similar results. Publication bias was non-significant for all the outcomes.ConclusionWhile visual deficits improved after EETS in the majority of patients, complete recovery was only achieved in less than half of the patients and some patients even suffered from visual deterioration.Electronic supplementary materialThe online version of this article (doi:10.1007/s11102-017-0815-9) contains supplementary material, which is available to authorized users.

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