Various Strategies of Transsphenoidal Pseudocapsule-Based Extracapsular Resection in Noninvasive Functional Pituitary Adenomas and their Effectiveness and Safety

Abstract

Introduction: Increasing attention has been paid to the pseudocapsule-based extracapsular resection in transsphenoidal surgery for pituitary adenomas. Prior reports focused more on Cushing disease or nonfunctional pituitary adenomas. In this study we present systematic research, especially concerning all kinds of noninvasive functional pituitary adenomas (NIFPAs) adopting various strategies of extracapsular resection, in order to evaluate the effectiveness and safety of these surgical methods for NIFPAs.

Materials and methods: From October 2008 to November 2014, 116 patients suffering from NIFPAs underwent pseudocapsule-based extracapsular resection (ER) with different surgical strategies; that is, by a microscope or endoscope via the endonasal transsphenoidal approach. During the same period, 90 patients suffering NIFPAs also underwent traditional transsphenoidal intracapsular resection (IR). In different postoperative periods, we re-examined the endocrine series and recorded the complications. Enhanced magnetic resonance imaging examination was also performed three months later.

Results: In the ER and IR group, the tumors were completely removed in 97 (83.7%) and 62 (68.9%) cases, whereas the endocrine disorders were remitted in 89 (76.7%) and 53 (58.9%) cases, respectively. Statistical analyses to compare the overall complete resection rates and the overall endocrine remission rates in both groups showed significant differences (P = 0.028 and 0.006, respectively). Intraoperative rhinorrhea occurred in 26.7% patients of the ER group and 13.3% of the IR group, showing a significant difference (P = 0.019). Transient diabetes insipidus occurred in 73.3% patients of the ER group and 63.3% of the IR group, with no difference between groups (P = 0.126). There was no case with intracranial hematoma or pituitary crisis in both the groups.

Conclusion: With our various surgical strategies of ER, the patients can achieve content imaging resection, high and sustained endocrine remission, which are effective and safe for NIFPAs.

Keywords: Clinical research; endonasal transsphenoidal approach; extracapsular resection; functional pituitary adenoma; microscope; neuroendoscope; noninvasive pituitary adenoma; pseudocapsule; surgical strategy.

Conflict of interest statement

None