Results of Endoscopic Surgery in Patients with Pituitary Adenomas : Association of Tumor Classification Grades with Resection, Remission, and Complication Rates

Abstract

The endoscopic endonasal transsphenoidal approach is a widely-used method for the surgical treatment of pituitary adenomas. We aimed to evaluate the results of endoscopic surgery by comparing preoperative classification methods and investigating their relationship with postoperative resection and remission rates and complications. Methods : We retrospectively reviewed the medical records of 236 patients (118 males) who underwent surgery for pituitary adenomas. Preoperative Knosp classification, tumor size (TS), suprasellar extension (SSE), postoperative resection and remission rates, and complications were evaluated. Results : The follow-up period was 3 months to 6 years. The patients' ages ranged between 16 and 84 years. Endocrinologically, 114 patients (48.3%) had functional adenoma (FA), and 122 patients (51.7%) had non-functional adenoma (NFA). Among the FA group, 92 (80.7%) showed remission. A statistically significant difference was found between patients with and without remission in terms of the Knosp, TS, and SSE classifications (p<0.01). Knosp, TS, and SSE classification grades were found to be correlated with the resection rates (p<0.01). Meningitis was seen in seven patients (3.0%), diabetes insipidus in 16 (6.9%; permanently in two [0.9%]), and rhinorrhea in 19 (8.1%). Thirty-six patients (15.3%) developed pituitary insufficiency and received hormone replacement therapy. Conclusion :The resection categories and remission rates of FAs were directly proportional to the adenoma sizes and Knosp grades, while the degree of suprasellar growth further complicated resection and remission rates. Adenoma sizes less than 2 cm and SSEs less than 1 cm are associated with favorable remission and resection rates.

Analysis of neuroendoscopy for the treatment of macroadenomas and giant pituitary adenomas

“…Recent reports of surgical complications are consistent with those described in the current study (23)(24)(25)(26)(27)(28)(29). CSF leakage, for example, is a common complication of transsphenoidal neuroendoscopic resection (30), and there were 39 such cases in this series (9.1%).…”

Radiological Knosp, Revised-Knosp, and Hardy–Wilson Classifications for the Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary Adenomas: Study of 228 Cases

“…It was a first approach with the diagnostic tools available at that time (xrays and CT), where they use some radiological characteristics visible in those images (invasion and destruction of sellar floor bone). Nevertheless, some previous series found that suprasellar extension less than 10 mm was associated with favorable remission and resection rates (37). Similarly, Yang et al (38) described expressly that PAs with intracranial extension had increased surgical complications and a lower rate of gross total removal, although not describing Knosp grades.…”

Prognostic Models in Growth-Hormone- and Prolactin-Secreting Pituitary Neuroendocrine Tumors: A Systematic Review

“…Feature importance explanations showed that the Knosp grade was the most important variable for the partial model and the postoperative day 1 GH level, total resection, and Knosp grade were the three most important variables for the full model. Gross total resection was correlated in many studies with remission after transsphenoidal surgery, and the patients were more likely to have favorable endocrine and visual outcomes than those with incomplete resection [ 70 , 71 , 72 , 73 ].…”