Endoscopic Endonasal Transsphenoidal Surgery (EETS) for PitNETs: Outcomes in a Single Institution Over a Decade.

Objective To observe the correlation between the thickness of foveal ganglion cell-inner plexiform layer (GCIPL) and visual field mean defect before and after gamma knife treatment in patients of sellar region tumors with optic chiasmal compression. Methods This was a prospective case series. 72 eyes of 37 consecutive patients suffering from optic chiasmal compression of sellar region tumors treated with gamma knife were enrolled in the study. According to the change of visual field before and after gamma knife treatment, the patients were divided into three groups. There were 13 eyes of 7 patients in group 1 with no vision defect pre- and post-treated, 34 eyes of 17 patients in group 2 with improvement of visual field defect after treatment, 25 eyes of 13 patients in groups 3 with no improvement or reorganization of visual field defect after treatment. Overall average thickness of GCIPL, and of the superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal retina were measured with the Cirrus high-definition spectral domain optical coherence tomography, and mean deviation (MD) with the Humphrey field analyzer before and 6 months after treatment. There was no significant difference in MD values between group 2 and 3 pre-treated (t=1.471, P=0.084). There was significant difference between all the groups in total average value of GCIPL thickness and the 6 quadrant GCIPL thickness values pre-treated (P<0.05). Logistic regression model was applied to analysis of the correlation between GCIPL thickness and the improvement of visual field after treatment. Results The MD values of the group 1, 2 and 3 were (-2.96 ± 0.75), (-10.24 ± 1.31), (-20.2 ± 5.88) dB at 6 months after treatment. There was significant difference between group 2 and 3 of MD value after treatment (t=6.974, P=0.000). In group 1, there was no significant difference in mean GCIPL thickness and the 6 quadrant GCIPL thickness values between pre- and post-treated(t=0.882, P=0.395). The mean thickness of GCIPL, superonasal and inferonasal GCIPL was increased than pre-treated in group 2, and the difference was statistically significant(t=2.438, 4.630, 4.457; P=0.035, 0.001, 0.001). The mean thickness of GCIPL, superonasal and inferonasal GCIPL was decreased than pre-treated in group 3, and the difference was statistically significant (t=-2.387, -4.603, -4.975; P=0.041, 0.002, 0.001). Logistic regression analysis showed that the greater of the value of average GCIPL thickness of patients with visual field defect pre-treated, the higher of the proportion of patients with improvement of visual field defect post-treated [odds ratio (OR)=2.871, P=0.000]. There was a significant correlation between the value of superonasal or inferonasal GCIPL and the improvement of the visual field post-treated (OR=5.374, 4.693; P=0.000, 0.000). There was no significant correlation between the value of superotemporal or upper or lower or inferotemporal GCIPL and the improvement of the visual field post-treated (OR=1.058, 1.101, 1.074, 1.056; P=0.183, 0.080, 0.162, 0.186). Conclusions In patients with optic chiasmal compression of sellar region tumor, the greater of the average GCIPL thickness pre-treated, the higher of the proportion of patients with improvement of visual field defect post-treated. There was a significant correlation between superonasal or inferonasal value of the GCIPL thickness and the improvement of visual field defect post-treated. Key words: Optic chiasm/ injuries; Retinal ganglion cells; Visual fields; Tomography, optical coherence

Tilted disc syndrome is a congenital anomaly of the eye characterized by mostly upper temporal visual field defects. The aim of the present study was to evaluate the effect of gradual myopic correction in the improvement of visual field defects associated with tilted disc syndrome. The visual field was examined in 38 eyes of 24 patients using standard Goldmann perimetry. The isoptres IV-4e, I-4e, I-3e and I-2e were plotted. The defective isoptres were tested again with gradually increasing myopic correction until no further change was noted. The most common type of defect was a relative upper temporal defect (19 eyes). Temporal relative defects were found in five eyes, upper altitudinal field defects in six eyes, an enlarged blind spot in four eyes, and an inferior field defect in one eye. The visual field defect partly or totally disappeared with increased myopic correction in 18 (50%) eyes. The mean improvement was 17.0 +/- 6.2 degrees and the mean additional myopic correction was 3.1 +/- 1.5 D. Even a small change in near correction during visual field examination may imply worsened or improved visual field defects in tilted disc syndrome. To prevent a false interpretation of field deterioration in a patient with tilted disc syndrome and glaucoma, visual field assessment should include examination with the myopic correction that provides the maximal improvement of the defective visual field.

PurposeThe objective of this study was to evaluate visual acuity (VA) and visual fields (VF) quantitatively before and after endonasal endoscopic transsphenoidal surgery (EETS), with special attention to the prognostic factors such as the tumors’ suprasellar dimension (SSD) and volume.MethodsA total of forty‐seven patients with pituitary adenomas operated by EETS were retrospectively evaluated. VA, VF and visual impairment score (VIS) calculated from VA and VFs were determined pre‐ and postoperatively. Tumors’ SSD and chiasmal contact were evaluated and correlation of tumor volume and SSD with pre‐ and postoperative visual function (VA, VF and VIS) was assessed.ResultsVA improved in 42% of eyes (n = 21) after EETS and 79% (n = 38) had normal VA postoperatively. Postoperative recovery in VF was observed in 86.5% (n = 32) eyes with VF defect. Mean VIS change was 11.6 (95% CI 7.3–16.0) and it improved in 96.0% of the patients (n = 24) with preoperative visual impairment. The mean SSD in patients with VF defect (n = 20) was 16.3 mm (95% CI 13.2–19.3) and in patients with no VF defects (n = 23) 7.5 mm (95% CI 5.9–9.2) (p &lt; 0.001). A cut‐off value of 10 mm for visual perturbations was determined for SSD and 5.1 ml for tumor volume (p &lt; 0.001 for both). A significant correlation between the tumor's SSD and volume with pre‐ and postoperative visual function was found.ConclusionsThe visual outcome after EETS for pituitary adenomas was excellent and significant complications were rare. The size (suprasellar dimension and volume) of pituitary adenoma was the most important predictor of visual outcome after EETS.

Objective To observe the changes in visual field defect before and after treatment in patients with acute solitary occipital lobe cerebral infarction. Methods From January 2017 to May 2019, 59 patients with hemianopsia who were diagnosed as acute occipital lobe cerebral infarction in Henan Provincial People's Hospital were selected. There were 35 males (59.3%) and 24 females (40.7%); aged from 50 to 72 years, with an average age of 62.86±6.10 years. There were 23 patients of right occipital cerebral infarction and 36 patients of left occipital cerebral infarction. Lesions involved 41 patients in the striated area, 8 patients involved the occipital pole, and 23 patients involved visual radiation. All patients underwent standard medical treatment. All patients underwent visual field examination before treatment, and modified rankin scale (mRS) was used to evaluate the level of visual disability after cerebral infarction. At 1, 3, and 6 months after treatment,54 patients underwent at least one visual field examination in outpatient or inpatient follow-up visits, and 5 patients were lost to follow-up; 49 patients received repeated mRS scores. The visual field defect and mRS score of patients before and after treatment were compared and analyzed. The improvement of visual field defect in the horizontal direction exceeding 10°or the vertical direction exceeding 15°was defined as improvement, otherwise it was defined as no improvement. According to the type of visual field defect, the patients were divided into two groups: complete homonymous hemianopia and incomplete homonymous hemianopia. The cumulative visual field improvement rate of the two groups of patients was calculated. An mRS score of 0 to 2 was defined as a good prognosis, and >2 was defined as a poor prognosis. Results Before treatment, of the 59 patients, 47 were complete homonymous hemianopsia and 12 were incomplete. Of the 47 patients with complete homonymous hemianopia, 26 patients had hemianopia on the right side of both eyes, 21 patients had hemianopia on the left side of both eyes; 32 patients with macular avoidance (72.3%). Among the 12 patients of incomplete homonymous hemianopia, 10 patients of quadrant blindness included 6 patients of upper quadrant and 4 patients of lower quadrant; 2 patients of partial isotropic hemianopia on one side. Of the 54 patients reviewed after treatment, the visual field improved at the last follow-up of 25 patients (46.3%), and there was no improvement in 29 patients (53.7%). The cumulative visual field improvement rate of 47 patients with complete hemianopia hemianopia before treatment was 37.2% (16/43). The cumulative visual field improvement rate of 11 patients with incomplete isotropic hemianopia before treatment was 81.8% (9/11). There was a statistically significant difference in cumulative visual field improvement between the two groups of patients (χ2 = 7.011, P<0.05). Before treatment, 59 patients had mRS scores of 1 to 2 points in 15 patients (25.4%), and 44 patients with 2 points or more (74.6%). Of the 49 patients reviewed after treatment, 28 (57.1%) had a good prognosis and 21(42.9%) had a poor prognosis. Conclusions The visual field defect of patients with homonymous hemianopsia after acute occipital infarction may be improved after treatment. The improvement mostly occurs within 1 m after treatment, and patients with incomplete homonymous hemianopsia have more significant improvements than those with complete homonymous hemianopsia. Key words: Occipital lobe; Cerebral infarction; Visual fields; Hemianopsia

Background: Ischemic stroke are lack of blood flow to the brain and it could influence the visual field. Approximately more than half of the ischemic stroke patient have visual defect.Objective : Disturbance of blood flow on visual pathway have impact to the visual field defect. In stroke ischemic patient, recirculation of penumbra at the brain on the third months after onset can rehabilitate the visual pathway, also it will improve the outcome of visual filed defect. So it could be initial detection for rehabiltation of visual field defect.Methods: This study was intended to compere visual field defect of ischemic stroke patient after three months therapy conducted form September 2014 - February 2015 in Mohammad Hoesin General Hospital Palembang. A total of 12 patients who met the inclusion criteria were recruited by consecutive sampling. All patients were endure based on ophthalmology and visual field examination using Humphrey Field Analyzer twice. First after relieving from the attack of stroke and second after three months therapy. Measurement of standard have to compare the value of MD, VFI, PSD, PD and pattern visual field defect. Results: There were significant difference in value of MD, VFI, PSD and PD&lt;0,5% for both eyes on stroke ischemic patients after three months therapy. Almost all variable value were increasing to improvement of defect. The most common type of visual field defect is homonymous hemianopia. Conclusion: There were improvement in visual field defect in patients with stroke ischemic after three months therapy.  Keywords: Ischemic stroke, visual field defect, penumbra, recirculation of brain, Mean Deviation (MD), Visual Field Index (VFI), Pattern Standard Deviasion (PSD), Pattern Deviation (PD)  Â

To analyze the perioperative course and clinical outcome of patients with large (lPA) and giant (gPA) pituitary adenoma who underwent endoscopic endonasal transsphenoidal surgery (EETS) using either two-dimensional (2D-E) or three-dimensional (3D-E) endoscopic systems. Single-center retrospective study of consecutive patients with lPA and gPA who underwent EETS between November 2008 and January 2023. LPA were defined as ≥ 3cm and < 4cm in diameter in at least one dimension and a volume of ≥ 10ccm; gPA were defined as larger than 4cm in diameter and with a greater volume than 10ccm. Patient data (age, sex, endocrinological and ophthalmological status) and tumor data (histology, tumor volume, size, shape, cavernous sinus invasion according to the Knosp classification) were analyzed. 62 patients underwent EETS. 43 patients were treated for lPA (69.4%) and 19 patients for gPA (30.6%). 46 patients (74.2%) underwent surgical resection using 3D-E and 16 patients 2D endoscopy (25.8%). Statistical results are referred to the comparison between 3D-E and 2D-E. Patients' age ranged from 23-88years (median 57), 16 patients were female (25.8%), 46 male (74.2%). Complete tumor resection was possible in 43.5% (27/62), partial resection in 56.5% (35/62). Resection rates did not differ between 3D-E (27 patients [43.5%]) and 2D-E (7 patients [43.8%], (p = 0.985). Visual acuity improved in 30 of 46 patients with preoperative deficit (65.2%). In the 3D-E group 21 of 32 patients (65.7%) improved, compared to 9 of 14 patients in the 2D-E group (64.3%). Improvement of visual field was achieved in 31 of 50 patients (62.0%; 22 of 37 patients in the 3D-E group [59.4%] and 9 of 13 patients in the 2D-E group [69.2%]). CSF leak was the most frequent complication and occurred in 9 patients (14.5%, [8 patients 17.4% 3D-E]) without statistical significance. Other surgical complications like postoperative bleeding, infection (meningitis) and deterioration of visual acuity and field were detected without statistical difference. New pituitary anterior lobe dysfunction was observed in 30 of 62 patients (48.4%, 8 patients [50.0%] in the 2D-E group and 22 patients [47.8%] in the 3D-E group). A transient deficit of posterior lobe was detected in 22.6% (14/62). No patient died within 30days of surgery. Although 3D-E may improve surgical dexterity, in this series of lPA and gPA it was not associated with higher resection rates compared to 2D-E. However, 3D-E visualization during resection of large and giant PA is safe and feasible and patient's clinical outcome is not different compared to 2D-E.

MRI–Negative Cushing's Disease: A Review on Therapeutic Management

The authors review their experience in the endoscopic endonasal transsphenoidal treatment of 5 patients, finally diagnosed as primary hypophysitis but initially assumed to be pituitary adenomas. A retrospective study was undertaken to review 5 cases of primary non-necrotizing granulomatous hypophysitis (1.61%) through 310 endoscopic transsphenoidally operated cases with the diagnosis of pituitary adenoma between 2009 and 2013. All 5 cases were female without any background of autoimmunity or recent pregnancy. The initial presumptive diagnosis was pituitary adenoma for all patients. The endocrinological diagnoses of the patients were suspected Cushing's Disease, anterior pituitary deficiency with hyponatremia, hyperprolactinemia, and acromegaly. One of the patients had normal hormonal levels. All patients had macroadenomas including one invasive adenoma with skull base involvement. One of the patients (20%) had visual field defects. All patients underwent endoscopic endonasal transsphenoidal surgery (EETS). All patients had improvement of hormonal levels postoperatively except the one with anterior pituitary deficiency who required long term hormone replacement after the surgery. Mean follow-up duration was 14.8 months. Primary granulomatous hypophysitis without any known etiological factors is very rare in the literature. It can mimic pituitary adenomas in radiological and endocrinological aspects. EETS is an effective and safe treatment especially for visual and compression symptoms.

Surgery for pituitary adenoma is indicated for relief of mass effect and control of endocrinopathy. Setting benchmarks for visual and hormonal outcomes is important for monitoring performance of surgical centres, while understanding the preoperative factors that predict endocrine cure and visual improvement facilitates tailored counselling for patients prior to surgery. A prospective, consecutive cohort of surgically managed (endoscopic transsphenoidal) pituitary adenoma (n = 304) were analysed. Preoperative and postoperative endocrine and visual field assessments were performed and compared to demographic, imaging and pathological data. Larger adenomas tended to have preoperative endocrine deficiency (p < 0.001) and visual field defects (p < 0.001). The largest tumours did not experience normalisation of their endocrinopathy or visual fields with surgery. Of the adenomas with normal preoperative endocrine function, 92.0% (126/137) maintained this postoperatively; only 2 of the 11 patients with new hypopituitarism required long-term hormone replacement. Functional tumour cure was achieved in 65.2% (86/116) after surgery; 74.4% (32/43) of acromegalics and 70.0 (35/50) of Cushing's disease patients achieved hormonal control. All patients with isolated hyperprolactinaemia from stalk effect normalised with surgery, while only 15.9% (7/44) with hypopituitarism recovered normal endocrine function. New hypopituitarism was predicted by younger age and functional adenoma, particularly Cushing's disease. Resolution of endocrinopathy was less likely with reoperative cases and those with cavernous sinus invasion (Knosp grade > 2) or preoperative ophthalmoplegia. One-third of the cohort (102/304, 33.6%) had a preoperative field cut, most commonly an incomplete (51.0%) or complete (31.4%) bitemporal hemianopsia. Only two patients (2/304, 0.7%) had visual field worsening after surgery, while 71.6% (73/102) experienced partial or complete resolution of their field cut after surgery. Complete resolution of visual field defect was predicted by younger age and incomplete bitemporal hemianopsia. Surgery is a safe and effective therapy for pituitary adenomas. Nearly all patients experience improvement in visual fields, especially the young and those with incomplete bitemporal defects. Reoperative cases and those with cavernous sinus involvement (high Knosp grade/ophthalmoplegia) are less likely to have resolution of endocrinopathy. Visual worsening, new ophthalmoplegia or endocrinopathy were rare complications of surgery.

Dopamine agonist for the rapid improvement of visual field defects in giant and macro-prolactinomas

Introduction: Granulomatous hypophysitis is a rare entity with an annual incidence of 1 in 10 million. It may be primary or secondary to tuberculosis, sarcoidosis, Wegener’s disease, syphilis or mycotic infections. It accounts for <1 % of cases of panhypopituitarism or visual field defects. Isolated Neurosarcoidosis without systemic involvement is extremely rare. It can rarely present as an isolated granuloma of the sella mimicking pituitary adenoma. Case: A 47-year-old-male was admitted with generalized weakness of 1 month and headache with loss of peripheral vision of 1 week duration. MRI brain revealed a sellar mass with suprasellar extension involving the pituitary stalk and hypothalamus representing pituitary macroadenoma. Biochemical tests were evident for central hypoadrenalism, secondary hypothyroidism and hypogonadism with mild hyperprolactinemia. He had low urine specific gravity on admission and provided history of increased thirst, polyuria and nocturia from past 3 weeks. CSF analysis showed elevated CSF protein and ACE levels. Visual field testing revealed bitemporal hemianopsia. Patient underwent transsphenoidal biopsy and partial resection of pituitary mass with significant improvement in visual field defects post operatively. Pituitary biopsy showed non-necrotizing granulomatous hypophysitis. CT chest revealed hilar and mediastinal lymphadenopathy suspicious of sarcoidosis. He had positive Quantiferon and PPD testing but hilar lymph node biopsy was negative for granuloma or malignancy. CSF analysis, pituitary and lymph node biopsy were negative for bacterial, AFB and fungal culture/stain. Tests for HIV, hepatitis, syphilis, lymphoma panel and sputum AFB culture x3 were negative. He was discharged on levothyroxine, hydrocortisone, testosterone and desmopressin. He completed treatment for latent TB and was monitored as outpatient. After 8 months, his visual field defects had completely recovered. Patient was asymptomatic with unchanged hilar and mediastinal lymphadenopathy. Repeat MRI brain showed avidly enhancing thickened pituitary stalk with complete resolution of pituitary mass lesion. He was diagnosed with probable Neurosarcoidosis and referred to rheumatology. Discussion: Hypothalamic-pituitary sarcoidosis occurs in less than 10% of patients with Neurosarcoidosis. Polyuria, polydipsia and signs and symptoms of hyperprolactinemia are the most common presenting manifestations. Earlier, the endocrine dysfunction was attributed to a destructive process affecting pituitary, but pituitary responsiveness to synthetic hypothalamic releasing factors indicates that hypothalamic insufficiency is the major cause for panhypopituitarism. Diabetes Insipidus can be masked by secondary adrenal deficiency on presentation. Clinicians should be cautious of unmasking diabetes insipidus while replacing glucocorticoids in such cases. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Disclosure: S. Sharma: None. M. Acharya: None. C. Sherpa: None. Introduction: Prolactinomas are the most common form of pituitary adenomas of which micro-prolactinomas comprise of 90% and measure less than 1 cm and occur mostly in women. Giant prolactinoma, defined as a prolactinoma &amp;gt;4 cm, serum prolactin concentration higher than 1000 ng/mL, and invasive tumor growth pattern with mass effects occur mostly in men. Giant prolactinomas have an estimated prevalence of 0.5-4.4% of all pituitary tumors. We report a case of giant prolactinoma causing optic nerve compression that responded well to Cabergoline. Case description: 47-year-old male with no significant past medical history was having vision disturbances for 6 months which included blurry vision and was seen by ophthalmologist. Visual field testing was done and was found to have bitemporal visual field defect/heteronymous hemianopia which prompted an emergent MRI of brain which showed 4.1x3.1x3.1 cm pituitary macroadenoma with suprasellar extension compressing the optic chiasm and optic nerves as well as the inferior anterior portion of the third ventricle and adjacent cerebrum. He was referred to neurosurgery and endocrinology. He reported intermittent headaches occurring 3-4 times a week. Denied any weakness, bowel/bladder incontinence. He denied any significant weight gain or weight loss, no palpitations, or severe fatigue. Hormonal work up showed: Elevated Prolactin level 9226 ng/ml (Reference range 2-18 ng/ml), Low Total testosterone was 213 ng/dL (Reference range 250-1100 ng/dL), low free testosterone 31.3 pg/ml (Reference range 35-155 pg/ml), with inappropriately normal luteinizing hormone and follicle stimulating hormone consistent with central hypogonadism. Thyroid stimulating hormone, free thyroxine, adrenocorticotropic hormone, am cortisol, Insulin like growth factor-1, and serum sodium were normal. He was seen in endocrinology clinic and started on cabergoline 0.5 mg twice a week. Repeat prolactin level in 3 weeks decreased to 285 ng/ml. Repeat visual field testing in 2 weeks after starting cabergoline showed that the bitemporal visual field defect had improved. His headache has improved and has intermittent episodes of dizziness. Discussion: There are few case reports describing giant prolactinoma, however there are no clear guidelines for management of giant prolactinomas causing optic nerve compression leading to visual field defects. Medical management of prolactinomas include dopamine agonists like Cabergoline, bromocriptine which are first line. The dilemma between choosing medical versus surgical management occurs in cases where there is worsening of visual field defects. Our case report highlights the drastic improvement in visual field defect and prolactin level after starting cabergoline within 3 weeks. Presentation: 6/2/2024

Although most pituitary neuroendocrine tumors (PitNETs) show benign behavior, a significant number of PitNETs exhibit an aggressive course including cavernous sinus (CS) invasion. To date, the cause of CS invasion has not been fully elucidated. In this study, we analyzed the relationship between CS invasion in PitNETs and the expression of PITX2 and SNAIL1, which are the transcription factors associated with the morphogenesis of pituitary gland. Sixty cases with non-functional PitNETs were classified into four types: type 1a, none of CS invasion and suprasellar expansion; type 1b, suprasellar expansion without CS invasion; type 2a, CS invasion without suprasellar expansion; and type 2b, CS invasion with suprasellar expansion. We analyzed the expression of PITX2 and SNAIL1 employing quantitative real-time polymerase chain reaction (qPCR) and immunohistochemistry. Other parameters such as mitotic count, Ki-67 index, and p53 expression were also analyzed, which were previously reported as potential tumor proliferative markers in PitNETs. PITX2 expression was significantly higher in PitNETs with CS invasion than PitNETs without CS invasion (P = 0.019). Expression of SNAIL1 was significantly elevated in PitNETs with suprasellar expansion compared with PitNETs without suprasellar expansion (P = 0.02). There was no apparent relationship between CS invasion and mitotic count, Ki-67 index, and p53 expression (mitotic count, P = 0.11; Ki-67 index, P = 0.61; p53, P = 0.66). High PITX2 expression was observed in non-functional PitNETs with CS invasion, suggesting that PITX2 may be involved in CS invasion of PitNETs.

To investigate the surgical outcomes in patients with nonfunctional pituitary adenomas (NFPAs) exhibiting visual field defects (VFDs) in order to ascertain the impact of the volume of adenoma excised during surgery on recurrence rates and improvements in VFDs. From a cohort of 150 individuals diagnosed with NFPAs and exhibiting suprasellar extensions accompanied by VFDs, we selected 114 patients who fulfilled the inclusion criteria for further analysis after a comprehensive retrospective review. All selected patients underwent pituitary magnetic resonance imaging (MRI) examinations, and volumetric measurements were conducted on T1 contrast sequences using the Syngo.via software. Measurements were derived from MRI scans taken 24 h preoperatively, 24 h postoperatively, at 3 months, and at the end of the first year postsurgery. Volumetric values were compared between patients who underwent subsequent surgeries due to recurrence and those who did not. Similarly, the variables were evaluated in patients experiencing an improvement in VFD, those whose VFD remained stable, and those experiencing a deterioration in VFD. The recurrence rate was 19.3%. Among patients who underwent a second surgery due to recurrence, the presurgical adenoma volume, the adenoma volume removed based on the 24-h postoperative MRI, and the volumes recorded in the 3-month and 1-year postoperative imaging were significantly greater than those in patients who did not require a second surgery. Remarkable improvements were identified in 84.2% of patients with VFD complaints and 62.5% of those with visual acuity complaints. Adenoma volume measurements exerted a significant impact on recovery from VFDs and the need for a second surgery. Although the choice of surgical methodology does not definitively affect outcomes, an in-depth evaluation of variations in adenoma volume can provide valuable prognostic insights.

Pediatric pituitary adenomas (pPAs) are uncommon. Thus, their presentation and outcomes after treatment are less well-understood than those of pituitary adenomas in adulthood (aPAs). A retrospective chart review was conducted for all patients who underwent endoscopic endonasal transsphenoidal surgery (EETS) for pPA at NewYork-Presbyterian Hospital/Weill Cornell Medicine (NYP/WCM) from 2005-2020. Eleven patients were identified, and information pertaining to age, sex, adenoma characteristics, procedural details, and outcomes was reviewed. A systematic review of the literature was also performed to compare outcomes of EETS versus microscopic endonasal transsphenoidal surgery (METS) for pPA. From 2005-2020, 11 patients underwent EETS for pPA at NYP/WCM. Mean age at operation was 14.9 ± 2.7years, and 5 patients (45.5%) were male. 10 adenomas (90.9%) were hormone-producing. Of the functional adenomas, 8 (80.0%) were PRL-secreting and 2 (20.0%) were GH-secreting. Maximum adenoma diameter (MAD) ranged from 1.2-5.1cm, with a median of 1.55cm. Cavernous sinus invasion (CSI) occurred in 2 patients with macroprolactinoma. Gross total resection (GTR) was achieved in 10 (90.9%). Biochemical remission occurred in 5/10 (50.0%). Post-operative complications were documented in 8 cases (72.7%) and included diabetes insipidus, hypopituitarism, sinusitis, weight gain, cerebrospinal fluid leak, meningitis, and hydrocephalus. Systematic literature review of 105 microscopic and 175 endoscopic cases revealed high frequency of hormone-producing tumors (83.6%) and similar rates of GTR (82.4% vs 85.1%) and biochemical cure (75.8% vs 64.3%). pPAs are more likely to be hormone producing and may be more aggressive and difficult to cure than aPAs. EETS is an effective treatment, although complication rates may be higher than in adult populations.