The surgical resection of functional pituitary adenomas (FPAs) resulting in hypersecretion
of pituitary hormones can be challenging and the rates of postoperative biochemical
remission (BR) are highly variable. The authors review their experience with a side-cutting
aspiration device (NICO Myriad, Indianapolis, IN) for resection of the gland-tumor
interface during endoscopic endonasal resection of FPAs.
33 consecutive FPAs (14 ACTH-secreting, 13 GH-secreting, 6 prolactinomas) treated
over a 3 year period at a single institution were reviewed. Each patient was treated
with an endonasal endoscopic approach. En bloc tumor removal was attempted when possible.
Alternatively, ring curettage and micropituitary rongeurs were used for piecemeal
resection. At the surgeon's discretion, the side-cutting aspiration device was used
in select cases for resection of the gland-tumor interface to mobilize any remaining
fragments of the lesion or remove the neoplastic capsule.
In 18 procedures, the device was used to shave the gland-tumor interface as part of
the surgical resection after standard endoscopic resection. These were compared with
15 contemporaneously treated FPAs in which the device was not used.
Overall, postoperative BR rate in the entire cohort of patients was 55% (18 of 33).
Although there was no statistical difference in the rate of BR in the groups in which
the aspiration device was used or not, the use of the device did not result in statistically
more intraoperative CSF leaks or rates of new postoperative endocrinopathies. The
only significant factor determining postoperative BR rates was the invasiveness of
the tumor based on Knosp grade (BR group: 1.1 ± 0.8, no BR group: 2.2 ± 1.0, p = 0.004).
We have found the side-cutting aspiration device to be a safe and effective adjunct
in the surgical treatment of FPAs, particularly for the resection of the gland–tumor
interface after standard endoscopic microsurgical technique. Its low profile is particularly
well suited to the narrow corridors often required of microadenoma resection, allowing
for maximal surgical removal without additional morbidity.
