Postoperative complications after endoscope-assisted transsphenoidal surgery for pituitary adenomas: a case series, systematic review, and meta-analysis of the literature

Stefanidis, Petros; Kyriakopoulos, Georgios; Athanasouli, Fani; Mytareli, Chrysoula; Georgios, Τzanis; Korfias, Stefanos; Stamatios, Theocharis; Angelousi, Anna

doi:10.1007/s42000-022-00362-1

Cited by 7 publications

(5 citation statements)

References 48 publications

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“…However, most reports focus more on the characteristics of tumor growth and surgical techniques which include pituitary gland and stalk manipulation during the operation [14]. As previously mentioned, larger tumor size, higher grade, pituitary apoplexy, multiple surgeries, and invasion of the dura or cavernous sinus are all risk factors for new pituitary dysfunction [38][39][40]. Compared with a microscope, the use of an endoscope may preserve pituitary function better with a similar degree of resection [41].…”

Section: Discussionmentioning

confidence: 99%

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

Nie

Fang

Wong

et al. 2022

Preprint

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Purpose： Currently, endoscopic transsphenoidal surgery is the main treatment for pituitary neuroendocrine tumors (PitNets). Excision of the tumor may have positive or negative effects on pituitary endocrine function and the pituitary function of somatotroph tumors is a point of particular concern after the operation. This study aimed to conduct a meta-analysis on the effect of endoscopic transsphenoidal somatotroph tumor resection on pituitary function. Methods： A systematic literature search was conducted for articles that included the evaluation of pituitary target gland before and after endoscopic transsphenoidal pituitary adenoma resection and published between 1992 and 2022 in PubMed, Cochrane, and Ovid MEDLINE. Results： 68 studies that included biochemical remission rates in 4524 somatotroph tumors were concluded. According to the 2000 consensus, the biochemical remission rate after transsphenoidal endoscopic surgery was 66.4% (95%CI,0.622-0.703; P = 0.000), the biochemical remission rate was 56.2% according to the 2010 consensus (95%CI,0.503-0.620; P = 0.041), and with the rate of biochemical remission ranging from 30.0% to 91.7% with investigator's definition. After endoscopic resection, adrenal axis dysfunction was slightly higher than that before surgery, but the difference was not statistically significant. Hypothyroidism was 0.712 times higher risk than that before surgery（OR=0.712; 95%CI, 0.527-0.961; P=0.027). Hypogonadism was 0.541 times higher risk than that before surgery (OR=0.541; 95%CI,0.393-0.746; P = 0.000). Hyperprolactinemia was 0.131 times higher risk than that before surgery (OR=0.131; 95%CI,0.022-0.783; P = 0.026). The incidence of pituitary insufficiency was 1.344 times risk before surgery after endoscopic resection of somatotroph tumors, but the difference was not statistically significant. Conclusions： Although the biochemical response rate of patients with transsphenoidal endoscopic growth hormone tumor resection will be increased as endoscopic surgery matures, some patients still require postoperative treatment, including gamma-ray therapy or drug take-in. Long-term follow-up and drug replacement therapy are required for newly diagnosed pituitary dysfunction, while the existing preoperative hypophysis can be ameliorated to some extent.

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Section: Discussionmentioning

confidence: 99%

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

Nie

Fang

Wong

et al. 2022

Preprint

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“…(2022) провели системний огляд післяопераційних ускладнень при хірургії аденом гіпофіза та повідомили про 9,2% випадків гіпопітуїтаризму у вибірці із 110 хірургічних випадків ендоскопічного лікування (p=0,009). Уперше виявлено нецукровий діабет у 12,2% пацієнтів (p=0,049) [24].…”

Section: рис 3 інтраопераційна візуалізація порожнини ііі шлуночка пі...unclassified

Endoscopic endonasal surgical management of giant pituitary adenomas with extension into ventricle system

Guk,

Ukrainets

2023

Ukr Neurosurg J

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Objective: to estimate the results of endoscopic endonasal surgical management of giant pituitary adenomas (GPAs) with extension into ventricular system (VS), to study the peculiarities of surgical techniques. Materials and methods. 49 adult patients with GPAs with extension into VS were included in the study. The depth of research 2016-2021. This is a consecutive sampling of 1339 pituitary adenomas. GPAs with extension into VS made up 3.66% (49/1339) among all treated pituitary adenomas, and 43.4% among 113 GPAs. Distribution by gender – 18 (36.7%) women and 31 (63.3%) men. Average age was 54.1±11.3 years. Results. The largest consecutive series of GPAs with extension into VS that underwent endoscopic endonasal surgery was analyzed. Gross total resection was achieved in 32.7% (16/49), subtotal – 42.9% (21/49), partial – 12.2% (6/49), contraindications for tumor removal were issued in 12.2% (6/49) cases, these patients underwent extended biopsy and ventriculoperitoneal shunting in 4 patients. In 67.4% (33/49) was admitted visual function improvement. In 12.2% (6/49) vision remained at preoperative level, with no visual impairment. In 20.4% (10/49) of cases, vision deteriorated immediately after surgery. Upon re-examination at 6‒8 weeks in this group, vision returned to baseline in 60% (6/10) of patients. An immunohistochemical study found that 89.8% of the tumors were hormonally inactive. There was allocated a separate group of null cell pituitary adenomas, which accounted for 18.9% of cases. ACTH, LH-FSH, GH, TTH, prolactin secreting PAs were detected in 30.6%, 24.5%, 16.3%, 8.2% and 2.0% respectively. Hypopituitarism was diagnosed in 30.6% (15/49) of patients. Diabetes insipidus was detected for the first time in the postoperative period in 12.2% (6/49) of patients. 14.3% (7/49) of the cases of postoperative cerebrospinal fluid leak were diagnosed. Meningitis developed in 8.1% (4/49). The mortality rate was 6.1% (3/49). Conclusions. An analysis of complications in the early postoperative period found that the incidence of complications in GPAs with extension into VS was statistically significantly higher when compared to the cohort of patients who underwent endoscopic endonasal surgery for pituitary adenomas removal, indicating the complexity of this pathology. Despite the significant increase in the complexity of endoscopic interventions and still considerable threats of postoperative cerebrospinal fluid leak in the opening of the VS, we can already consider endonasal operations in the vast majority of GPAs as the method of choice. A new classification approach to the study group of GPAs was proposed. It allows us to separate the relatively low-risk and high-risk groups of high-flow intraoperative cerebrospinal fluid leak, which is directly correlated with the risks of postoperative complications and mortality in our study. In addition, we emphasize a special, although the smallest group of GPAs with extension into the third ventricle (type 3). Such cases require special attention and the decision to have ventriculoperitoneal shunting before or immediately after the removal of the tumor.

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“…After autopsy in people who are not diagnosed with pituitary adenoma, it has been found that more than 10% of people had pituitary adenomas (Bing, 2021). Although most of pituitary adenoma are benign tumours and can be removed, the patients still have some uncomfortable symptoms after operation, resulting in impaired quality of life (Graffeo et al, 2022; Rosinha et al, 2022; Stefanidis et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Fatigue, sleep and physical activity in postoperative patients with pituitary adenomas: A survey

She,

Wu,

et al. 2024

Int J of Nursing Practice

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BackgroundThe condition and correlation of fatigue, sleep and physical activity in postoperative patients with pituitary adenomas remain unclear. This survey aimed to evaluate the current status and influencing factors of fatigue, sleep and physical activity in postoperative patients with pituitary adenomas.MethodsPatients undergoing pituitary adenoma resection in two tertiary hospitals from November 2019 to November 2021 were included. The general data questionnaire, Multidimensional Fatigue Inventory (MFI‐20), Pittsburgh Sleep Quality Index (PSQI) and international physical activity questionnaire were used for data analysis.ResultsIn total, 184 patients with pituitary adenomas were included. The postoperative patients with pituitary adenomas had a high level of fatigue. In total, 34 (18.5%) patients had low level of physical activity, 76(41.3%) patients had medium level of physical activity and 74 (40.2%) had high level of physical activity. Postoperative time, PSQI, physical activity level and gender were the influencing factors of fatigue in patients with pituitary adenomas (all P < 0.05).ConclusionsPostoperative patients with pituitary adenomas have a higher level of fatigue, and it is related to reduced sleep quality and activity. Relevant nursing measures should be taken according to the influencing factors of fatigue to reduce the fatigue of postoperative patients with pituitary adenomas.

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Postoperative complications after endoscope-assisted transsphenoidal surgery for pituitary adenomas: a case series, systematic review, and meta-analysis of the literature

Cited by 7 publications

References 48 publications

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

Endoscopic endonasal surgical management of giant pituitary adenomas with extension into ventricle system

Fatigue, sleep and physical activity in postoperative patients with pituitary adenomas: A survey

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