Intraoperative unfolding and postoperative pruning of the pituitary gland after transsphenoidal surgery for pituitary ad
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ENDOCRINE SURGERY
Intraoperative unfolding and postoperative pruning of the pituitary gland after transsphenoidal surgery for pituitary adenoma: A volumetric and endocrinological evaluation Victor E. Staartjes1 Sarah Stricker2 Giovanni Muscas3 Nicolai Maldaner1 David Holzmann4 Jan-Karl Burkhardt1 Burkhardt Seifert5 Christoph Schmid6 Carlo Serra1 Luca Regli1 ●
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Received: 3 July 2018 / Accepted: 10 September 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Purpose To describe the volumetric changes that the pituitary gland (PG) undergoes during and after transsphenoidal surgery (TSS), and to evaluate if unfolding and/or pruning are related to endocrinological outcome measures. Methods Retrospective evaluation of data prospectively collected of a cohort of patients undergoing TSS for a pituitary adenoma with the adjunctive use of high field 3 Tesla intraoperative MRI. All patients underwent a full endocrinological workup preoperatively, as well as at 6 weeks and 1 year postoperatively. A decrease in PG volume ≥15% between the intraoperative and 3-month, or between the 3-month and 12-month measurements, was considered early and late pruning, respectively. Results The PG unfolds significantly during TSS, and subsequently undergoes pruning up until 1 year postoperatively, in most cases returning to the preoperatively measured PG volume. A smaller baseline PG volume predicts intraoperative unfolding. Early pruning of the PG after surgery was associated with new functional deficits. Baseline pituitary compression also correlated to newly occurring deficits after surgery. A larger 1-year pituitary volume was associated with biochemical remission in secreting adenomas. Conclusions The PG shows dynamic change during and after TSS for pituitary adenoma. Small baseline and 3-month PG volumes, as well as early pruning were independently associated with new deficits. Our findings warrant prospective validation in a larger cohort with higher statistical power. Keywords Pituitary surgery Hormonal function Outcome prediction Pituitary adenoma Transsphenoidal surgery ●
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Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12020-018-1758-2) contains supplementary material, which is available to authorized users.
Transsphenoidal surgery (TSS) is a well-established treatment for pituitary adenoma, and constant technical improvements have led to safer and more extensive resections with a low rate of recurrence and minimal perioperative morbidity and mortality [1–6]. Among other improvements, intraoperative high field strength magnetic
* Carlo Serra [email protected]
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Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Department of Biostatistics; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Department of Endocrinology and Diabetes, University Hospita
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