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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2023; 42(02): e89-e100
DOI: 10.1055/s-0043-1769777
Original Article | Artigo Original

Endoscopic Transsphenoidal Surgery of Pituitary Adenomas: Preliminary Results of the Neurosurgery Service of Hospital Cristo Redentor

Cirurgia endoscópica transesfenoidal de adenomas pituitários: resultados preliminares do Serviço de Neurocirurgia do Hospital Cristo Redentor
Gerson Perondi 
1   Department of Neurosurgery, Neurosurgery Service, Hospital Cristo Redentor, Porto Alegre, RS, Brazil
,
Afonso Mariante
2   Department of Otolaryngology, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil
,
Fernando Azambuja
3   Department of Endocrinology and Metabolism, Hospital Nossa Senhora da Conceição, Porto Alegre, RS, Brazil
,
Gabriel Frizon Greggianin 
1   Department of Neurosurgery, Neurosurgery Service, Hospital Cristo Redentor, Porto Alegre, RS, Brazil
,
Wanderson William dos Santos Dias 
1   Department of Neurosurgery, Neurosurgery Service, Hospital Cristo Redentor, Porto Alegre, RS, Brazil
,
Giulia Pinzetta
4   Department of Internal Medicine, School of Medicine, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
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Abstract

Objective The transsphenoidal surgery is a safe and effective technique to manage different skull base pathologies, such as pituitary adenomas. The purpose of the present study is to describe the initial experience with endoscopic transsphenoidal surgery in the treatment of pituitary adenoma patients at a tertiary hospital that is a reference in neurosurgery in Southern Brazil.

Materials and Methods We retrospectively analyzed data from 60 patients with pituitary adenoma who underwent endoscopic transsphenoidal surgery between 2012 and 2019. Demographic characteristics, type of tumor, baseline hormonal changes, and clinical presentation were reported, as well as postoperative outcomes, tumor resection rate, and complications.

Results The male/female ratio was of 0.53:1, and the mean age of the sample was of 54 (range: 26 to 79) years. In total, 34 patients (57%) presented the non-functioning adenoma subtype, and 26 (43%), the functioning adenoma subtype. In the non-functioning and functioning subtype groups, the average tumor diameter was of 32 mm and 18 mm, and the mean follow-up was of 27 months and 32 months respectively. Regarding visual symptoms, 79% of the patients showed improvement after surgery. Hormonal remission was achieved in 71% of the patients with prolactinoma, 85% of those with cushing, and 57% of patients with acromegaly. Overall, gross total resection (GTR) was achieved in 50% of patients but with a significantly lower rate among patients with tumors with parasellar growth (high grade on the Knosp classification). The most prevalent surgical complications observed were postoperative cerebrospinal fluid (CSF) leak and meningitis in 11% and 6% of the cases respectively.

Conclusion We have shown that transsphenoidal endoscopic surgery can produce good results in the management of pituitary adenomas, with acceptable peri- and postoperative morbidity and mortality. Regardless of the technique used, the presence of large and giant pituitary adenomas with a high Knosp grade represents an enormous challenge for contemporary neurosurgery.

Resumo

Objetivo A cirurgia transesfenoidal é uma técnica segura e eficaz para o tratamento de patologias da base do crânio, como os adenomas hipofisários. O objetivo deste estudo é demonstrar a experiência inicial com a cirurgia endoscópica transesfenoidal no tratamento de pacientes com adenoma hipofisário em hospital terciário, referência em neurocirurgia no Sul do Brasil.

Materiais e Métodos Analisamos retrospectivamente os dados de 60 pacientes com adenoma hipofisário submetidos à cirurgia endoscópica transesfenoidal entre 2012 e 2019. Características demográficas, tipo de tumor, alterações hormonais basais e apresentação clínica foram relatadas, bem como evolução pós-operatória, grau de ressecção tumoral e complicações.

Resultados A proporção homem/mulher foi de 0.53:1, e a idade média da amostra foi de 54 (variação: 26 a 79) anos. Ao todo, 34 pacientes (57%) tinham o subtipo funcional de adenoma, e 26 (43%), o subtipo não funcional de adenoma. Nos grupos não funcional e funcional, o diâmetro médio do tumor foi de 32 mm e 18 mm, e o tempo médio de acompanhamento foi de 27 meses e 32 meses, respectivamente. Em relação aos sintomas visuais, 79% dos pacientes apresentaram melhora após a cirurgia. A remissão hormonal foi alcançada em 71% dos pacientes com adenomas secretores de prolactina, em 85% daqueles com adenomas secretores de hormônio adrenocorticotrófico e em 57% dos pacientes com adenomas secretores de hormônio do crescimento. A ressecção total foi obtida em 50% dos pacientes, mas com taxa significativamente menor em pacientes com tumores com crescimento parasselar (grau elevado na classificação de Knosp). As complicações cirúrgicas mais prevalentes observadas foram fístula liquórica pós-operatória e meningite, em 11% e 6% dos casos, respectivamente.

Conclusão Demostramos que a cirurgia endoscópica transesfenoidal pode produzir bons resultados no manejo de adenomas hipofisários, com aceitável morbimortalidade peri e pós-operatória. Independentemente da técnica utilizada, a presença de adenomas hipofisários grandes e gigantes com grau de Knosp elevado representa um enorme desafio para a neurocirurgia contemporânea.

Keywords

endoscopic surgery - pituitary gland - epidemiology - adenoma

Palavras-chave

cirurgia endoscópica - glândula pituitária - epidemiologia - adenoma


Publication History

Received: 10 November 2021

Accepted: 24 January 2023

Article published online:
28 June 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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