Outcomes and Complications of Aggressive Resection Strategy for Pituitary Adenomas in Knosp Grade 4 With Transsphenoidal Endoscopy
Surgery for pituitary adenomas (PAs) with cavernous sinus (CS) invasion in Knosp grade 4 is a great challenge and whether to adopt a conservative or aggressive surgical strategy is controversial. The aim of this study is to provide the outcomes and complications of an aggressive resection strategy f...
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| Format: | Article |
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Frontiers Media S.A.
2021-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.693063/full |
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| author | Taohui Ouyang Na Zhang Shenhao Xie Bin Tang Junjun Li Limin Xiao Fabao Zhang Bowen Wu Dongwei Zhou Meihua Li Tao Hong |
| author_facet | Taohui Ouyang Na Zhang Shenhao Xie Bin Tang Junjun Li Limin Xiao Fabao Zhang Bowen Wu Dongwei Zhou Meihua Li Tao Hong |
| author_sort | Taohui Ouyang |
| collection | DOAJ |
| description | Surgery for pituitary adenomas (PAs) with cavernous sinus (CS) invasion in Knosp grade 4 is a great challenge and whether to adopt a conservative or aggressive surgical strategy is controversial. The aim of this study is to provide the outcomes and complications of an aggressive resection strategy for Knosp grade 4 PAs with transsphenoidal endoscopic surgery. Outcomes and complications were retrospectively analyzed in 102 patients with Knosp grade 4 PAs. Among them, primary PAs were seen in 60 patients and recurrent PAs were seen in 42 cases. Gross total resection (GTR) of the entire tumor was achieved in 72 cases (70.6%), subtotal tumor resection (STR) in 18 cases (17.6%), and partial tumor resection (PTR) in 12 cases (11.8%). Additionally, GTR of the tumor within the CS was achieved in 82 patients (80.4%), STR in 17 patients (16.7%), and PTR in 3 patients (2.9%). Statistical analyses showed that both recurrent tumors and firm consistency tumors were adverse factors for complete resection (P<0.05). Patients with GTR of the entire tumor were more likely to have favorable endocrine and visual outcomes than those with incomplete resection (P<0.05). Overall, the most common surgical complication was new cranial nerve palsy (n=7, 6.8%). The incidence of internal carotid artery (ICA) injury and postoperative cerebrospinal fluid (CSF) leakage was 2.0% (n=2) and 5.9% (n=6), respectively. Six patients (5.9%) experienced tumor recurrence postoperatively. For experienced neuroendoscopists, an aggressive tumor resection strategy via transsphenoidal endoscopic surgery may be an effective and safe option for Knosp grade 4 PAs. |
| first_indexed | 2024-12-21T16:40:06Z |
| format | Article |
| id | doaj.art-75d8a70f1a1b4c93bc4c7809d6476c95 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-21T16:40:06Z |
| publishDate | 2021-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-75d8a70f1a1b4c93bc4c7809d6476c952022-12-21T18:57:07ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-06-011110.3389/fonc.2021.693063693063Outcomes and Complications of Aggressive Resection Strategy for Pituitary Adenomas in Knosp Grade 4 With Transsphenoidal EndoscopyTaohui Ouyang0Na Zhang1Shenhao Xie2Bin Tang3Junjun Li4Limin Xiao5Fabao Zhang6Bowen Wu7Dongwei Zhou8Meihua Li9Tao Hong10 Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, ChinaDepartment of Neurology, the First Affiliated Hospital of Nanchang University, Nanchang, China Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, ChinaDepartment of Neurosurgery, Wuhan Union Hospital, Wuhan, China Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, ChinaDepartment of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, China Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, Nanchang, ChinaSurgery for pituitary adenomas (PAs) with cavernous sinus (CS) invasion in Knosp grade 4 is a great challenge and whether to adopt a conservative or aggressive surgical strategy is controversial. The aim of this study is to provide the outcomes and complications of an aggressive resection strategy for Knosp grade 4 PAs with transsphenoidal endoscopic surgery. Outcomes and complications were retrospectively analyzed in 102 patients with Knosp grade 4 PAs. Among them, primary PAs were seen in 60 patients and recurrent PAs were seen in 42 cases. Gross total resection (GTR) of the entire tumor was achieved in 72 cases (70.6%), subtotal tumor resection (STR) in 18 cases (17.6%), and partial tumor resection (PTR) in 12 cases (11.8%). Additionally, GTR of the tumor within the CS was achieved in 82 patients (80.4%), STR in 17 patients (16.7%), and PTR in 3 patients (2.9%). Statistical analyses showed that both recurrent tumors and firm consistency tumors were adverse factors for complete resection (P<0.05). Patients with GTR of the entire tumor were more likely to have favorable endocrine and visual outcomes than those with incomplete resection (P<0.05). Overall, the most common surgical complication was new cranial nerve palsy (n=7, 6.8%). The incidence of internal carotid artery (ICA) injury and postoperative cerebrospinal fluid (CSF) leakage was 2.0% (n=2) and 5.9% (n=6), respectively. Six patients (5.9%) experienced tumor recurrence postoperatively. For experienced neuroendoscopists, an aggressive tumor resection strategy via transsphenoidal endoscopic surgery may be an effective and safe option for Knosp grade 4 PAs.https://www.frontiersin.org/articles/10.3389/fonc.2021.693063/fullendoscopiccavernous sinuspituitary adenomaoutcomesurgery |
| spellingShingle | Taohui Ouyang Na Zhang Shenhao Xie Bin Tang Junjun Li Limin Xiao Fabao Zhang Bowen Wu Dongwei Zhou Meihua Li Tao Hong Outcomes and Complications of Aggressive Resection Strategy for Pituitary Adenomas in Knosp Grade 4 With Transsphenoidal Endoscopy Frontiers in Oncology endoscopic cavernous sinus pituitary adenoma outcome surgery |
| title | Outcomes and Complications of Aggressive Resection Strategy for Pituitary Adenomas in Knosp Grade 4 With Transsphenoidal Endoscopy |
| title_full | Outcomes and Complications of Aggressive Resection Strategy for Pituitary Adenomas in Knosp Grade 4 With Transsphenoidal Endoscopy |
| title_fullStr | Outcomes and Complications of Aggressive Resection Strategy for Pituitary Adenomas in Knosp Grade 4 With Transsphenoidal Endoscopy |
| title_full_unstemmed | Outcomes and Complications of Aggressive Resection Strategy for Pituitary Adenomas in Knosp Grade 4 With Transsphenoidal Endoscopy |
| title_short | Outcomes and Complications of Aggressive Resection Strategy for Pituitary Adenomas in Knosp Grade 4 With Transsphenoidal Endoscopy |
| title_sort | outcomes and complications of aggressive resection strategy for pituitary adenomas in knosp grade 4 with transsphenoidal endoscopy |
| topic | endoscopic cavernous sinus pituitary adenoma outcome surgery |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.693063/full |
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