Abstract
IntroductionThe endoscopic endonasal approach (EEA) is a safe and effective treatment for pituitary adenomas (PAs). Since extracapsular resection (ER) of PAs improves tumor resection and endocrine remission rates, the interface between the pseudocapsule and gland draws increasing attention. However, it is difficult to precisely dissect the tumor along the exact boundary, and complete removal of the tumor increases the risks of normal tissue damage and cerebrospinal fluid (CSF) leakage. In this study, we investigated the extracapsular resection as well as the pseudocapsule histology to evaluate the effectiveness and safety of pseudocapsule-related surgical interventions.MethodsFrom December 2017 to December 2019, 189 patients of PAs via EEA in our single center were analyzed retrospectively. The images, operative details, and clinical follow-up of patients were collected. Sixty-four patients underwent pseudocapsule-based ER, and 125 patients also underwent traditional intracapsular resection (IR) with or without intensive excision for FPAs. The clinical characteristics, tumor resection, endocrinological outcomes, and postoperative morbidities of the two groups were compared. Informed consent for publication of our article was obtained from each patient. Histological examination of pseudocapsule was performed using hematoxylin and eosin and reticulin staining.ResultsThe gross total recession was 62 (96.9%) in the ER group and 107 (85.6%) cases in the IR group, whereas the endocrine remission rate was 29/31 (93.5%) and 40/53 (75.5%) cases, respectively. Anterior pituitary functions were not aggravated postoperatively in any patient, but transient diabetes insipidus (DI) occurred more in the IR group (64.0%) than in ER (48.4%). Pseudocapsule specimens were obtained in 93 patients, and clusters of small cell aggregation were detected in 11 pseudocapsule specimens (11.8%) whereas other patients showed no remarkable developed pseudocapsule. Intraoperative CSF leak occurred more in the ER group (28.1%) than in the IR group (13.6%), but no difference was seen between two groups postoperatively. No case of intracranial hematoma or pituitary crisis occurred in both groups. After a mean follow-up of 22.8 months, tumor recurrence was observed in 4 (2.1%) cases.ConclusionPseudocapsule-based extracapsular resection of PAs via EEA is an effective and safe procedure to achieve complete resection with high and sustained endocrine remission and without deteriorating pituitary function.
Highlights
The endoscopic endonasal approach (EEA) is a safe and effective treatment for pituitary adenomas (PAs)
According to preoperative magnetic resonance imaging (MRI) findings, the tumors consisted of 56 microadenomas (
Identification of the adenoma edges is crucial to limiting the risk of damage to the pituitary gland and tearing of the arachnoid at the level of the diaphragm sellae; using the pseudocapsule as a surgical plane could be effective for surgeons to better confine the resection area [9]
Summary
The endoscopic endonasal approach (EEA) is a safe and effective treatment for pituitary adenomas (PAs). We investigated the extracapsular resection as well as the pseudocapsule histology to evaluate the effectiveness and safety of pseudocapsule-related surgical interventions. Over the last two decades, the endoscopic endonasal approach (EEA) has been extensively developed and refined for the resection of pituitary adenomas (PAs). The endoscopic panoramic view is superior in terms of efficacy and safety for sellar surgery, and studies have reported that PAs can be effectively resected by EEA with minimal postoperative morbidity [1]. The studies elaborated procedure along the outer face of the pseudocapsule between the adenoma and surrounding normal gland tissue achieved radical removal of the tumor while preserving normal pituitary function [4,5,6]. In recent years, extracapsular resection (ER), which emphasized the importance of pseudocapsule as a surgical plane, was adopted for more radical resection of the tumor [7]
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