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J Neurol Surg B Skull Base
DOI: 10.1055/a-2538-3928
Original Article

Multi-Center, Multi-National Outcomes Following Endoscopic Endonasal Resection of Nonfunctional Pituitary Adenomas

Robert G. Briggs
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Dhiraj J. Pangal
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Shane Shahrestani 
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
David J. Cote
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Stephanie K. Cheok
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Jacob Ruzevick
2   Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, United States
,
Ben A. Strickland
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Martin J. Rutkowski
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Ilaria Bove
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Jeffrey J. Feng
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Ishan Shah 
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
David Gomez
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Kyle M. Hurth
3   Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Mark Shiroishi
4   Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Bozena Wrobel
5   Department of Otolaryngology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
John D. Carmichael
6   Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
,
Alexander Micko
7   Department of Neurosurgery, Medical University of Graz, Styria, Austria
,
Stefan Wolfsberger
7   Department of Neurosurgery, Medical University of Graz, Styria, Austria
8   Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
,
Engelbert Knosp
7   Department of Neurosurgery, Medical University of Graz, Styria, Austria
8   Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
,
Luigi Cavallo
9   Division of Neurosurgery, School of Medicine and Surgery, Universitá degli Studi di Napoli Federico II, Naples, Italy
,
Paolo Cappabianca
9   Division of Neurosurgery, School of Medicine and Surgery, Universitá degli Studi di Napoli Federico II, Naples, Italy
,
Edward R. Laws
10   Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Gabriel Zada
1   Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
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Abstract

Objective Nonfunctioning pituitary adenomas (NFPA) are common, benign lesions of the pituitary gland. The endoscopic endonasal approach (EEA) has improved their treatment. Large multi-center data across different healthcare systems on outcomes following EEA resection of NFPA are limited. We aimed to provide highly generalizable benchmark outcomes from an international, multi-center review of EEA for NFPA resection.

Methods Institution-level data on symptoms, tumor and intraoperative characteristics, complications, and long-term outcomes were obtained from four tertiary pituitary centers located in the United States (2), Italy (1), and Austria (1). Means and weighted averages were used to generate descriptive statistics of patient characteristics and outcomes.

Results A total of 1,097 patients who underwent EEA for NFPA were included (mean age: 55.3 years). Presenting symptoms included vision loss (55.2%) and headache (42.1%). The most common preoperative endocrinopathies were hyperprolactinemia (26%) and hypothyroidism (18%). The gross total resection rate was 66%. Patients presenting with headache and visual symptoms experienced improvement (81 and 89%, respectively). Common complications included delayed hyponatremia (7.5%), transient arginine vasopressin deficiency (AVP-D; 6.6%), cerebrospinal fluid leak (3.5%), new endocrinopathy (3.5%), and new cranial nerve palsy (0.8%). There were no instances of carotid artery injury. Stroke (0.4%) and death (0.1%) were exceedingly rare. During the mean follow-up of 30 months, <5% of patients underwent reoperation or radiation-based treatments.

Conclusion In this large, international series, EEA proved a safe and effective intervention that was generalizable across centers in the United States and Europe. Severe complications were rare, and significant improvements in headache and vision loss were noted in most patients.

Keywords

pituitary - endoscopic - adenoma - nonfunctioning - transsphenoidal - endonasal


Publication History

Received: 25 October 2024

Accepted: 12 February 2025

Article published online:
03 March 2025

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