Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 142 No. 3940 (2012)

Pituitary surgery: experience from a large network in Central Switzerland

  • Sven Berkmann
  • Javier Fandino
  • Beat Müller
  • Karl F Kothbauer
  • Christoph Henzen
  • Hans Landolt
DOI
https://doi.org/10.4414/smw.2012.13680
Cite this as:
Swiss Med Wkly. 2012;142:w13680
Published
23.09.2012

Summary

PRINCIPLES: During the past years our group built a care network for patients with pituitary tumours with referrals from the midlands and the central part of Switzerland, comprising about 1.6 million inhabitants. The purpose of this retrospective observational study with longitudinal data is to review the experience of pituitary surgery and the operative outcome within this Swiss-wide largest network.

METHODS: A total of 182 patients operated at the Neurosurgical Department of the Kantonsspital Aarau 2005–2010 were included in this study. The follow-up was 3.6±1.6 years.

RESULTS: The following lesions were found: non-functioning adenoma (n = 114; 63%); macroprolactinoma (n = 18; 10%); microprolactinoma (n = 11; 6%); acromegaly (n = 11; 6%), Cushing’s disease (n = 7; 4%); Rathke’s cleft cyst (RCC; n = 9; 5%); others (n = 12; 7%). Intraoperative MRI (iMRI) was used in 115 (63%) patients. Preoperatively, hypopituitarism was found in 105 (58%) patients. Postoperative recovery of defunct axes was detected in 48%. Visual field and visual acuity deficits due to optic pathway compression by tumour were detected in 48% and 41% of the patients, respectively. Postoperative recovery of visual function was seen in 89%. The increase of total resection rate by iMRI was statistically significant (p = 0.0007). Recurrent tumour growth was seen in 5 (3%) patients during follow-up.

CONCLUSIONS: Transsphenoidal surgery is the primary treatment for most sellar lesions. The use of iMRI may lead to higher gross total resection rates. In Switzerland close cooperation between specialised centres is a very positive experience both to support operative case loads and to optimise patient follow-up.

References

  1. Buchfelder M, Schlaffer S. Surgical treatment of pituitary tumours. Best Pract Res Clin Endocrinol Metab. 2009;23(5):677–92.
  2. Freda PU, Beckers AM, Katznelson L, Molitch ME, Montori VM, et al. Pituitary incidentaloma: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(4):894–904.
  3. Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Kleinberg D, et al. Guidelines for acromegaly management: an update. J Clin Endocrinol Metab. 2009;94(5):1509–17.
  4. Melmed S, Casanueva FF, Hoffman AR, Kleinberg DL, Montori VM, Schlechte JA, et al. Diagnosis and treatment of hyperprolactinemia: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(2):273–88.
  5. Tang BN, Levivier M, Heureux M, Wikler D, Massager N, Devriendt D, et al. 11C-methionine PET for the diagnosis and management of recurrent pituitary adenomas. Eur J Nucl Med Mol Imaging. 2006;33(2):169–78.
  6. Lundin P, Pedersen F. Volume of pituitary macroadenomas: assessment by MRI. J Comput Assist Tomogr. 1992;16(4):519–28.
  7. Hardy J, Wigser SM. Transsphenoidal surgery of pituitary fossa tumors with televised radiofluoroscopic control. J Neurosurg. 1965;23(6):612–9.
  8. Shou XF, Li SQ, Wang YF, Zhao Y, Jia PF, Zhou LF. Treatment of pituitary adenomas with a transsphenoidal approach. Neurosurgery. 2005;56(2):249–56; discussion 249–56.
  9. Berkmann S, Fandino J, Zosso S, Killer HE, Remonda L, Landolt H. Intraoperative magnetic resonance imaging and early prognosis for vision after transsphenoidal surgery for sellar lesions. J Neurosurg. 2011;115(3):518–27.
  10. Berkmann S, Landolt H. Sinugene Meningitis bei Makroprolaktinom unter Dopamin-Agonisten. Forum Med Suisse. 2010;10(11):216–7.
  11. Ciric I, Ragin A, Baumgartner C, Pierce D. Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience. Neurosurgery. 1997;40(2):225–36; discussion 236–7.
  12. Ahmed S, Elsheikh M, Stratton IM, Page RC, Adams CB, Wass JA. Outcome of transphenoidal surgery for acromegaly and its relationship to surgical experience. Clin Endocrinol (Oxf). 1999;50(5):561–7.
  13. Fatemi N, Dusick JR, Mattozo C, McArthur DL, Cohan P, Boscardin J,, et al. Pituitary hormonal loss and recovery after transsphenoidal adenoma removal. Neurosurgery. 2008;63(4):709–18; discussion 18–9.
  14. Murad MH, Fernández-Balsells MM, Barwise A, Gallegos-Orozco JF, Paul A, Lane MA, et al. Outcomes of surgical treatment for nonfunctioning pituitary adenomas: a systematic review and meta-analysis. Clin Endocrinol (Oxf). 2010;73(6):777–91.
  15. Kreutzer J, Buslei R, Wallaschofski H, et al. Operative treatment of prolactinomas: indications and results in a current consecutive series of 212 patients. Eur J Endocrinol. 2008;158(1):11–8.
  16. Hofmann BM, Hlavac M, Martinez R, Buchfelder M, Muller OA, Fahlbusch R. Long-term results after microsurgery for Cushing disease: experience with 426 primary operations over 35 years. J Neurosurg. 2008;108(1):9–18.
  17. Bohinski RJ, Warnick RE, Gaskill-Shipley MF, et al. Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery. Neurosurgery. 2001;49(5):1133–43; discussion 43–4.
  18. Fahlbusch R, Ganslandt O, Buchfelder M, Schott W, Nimsky C. Intraoperative magnetic resonance imaging during transsphenoidal surgery. J Neurosurg. 2001;95(3):381–90.
  19. Hirschl RA, Wilson J, Miller B, Bergese S, Chiocca EA. The predictive value of low-field strength magnetic resonance imaging for intraoperative residual tumor detection. Clinical article. J Neurosurg. 2009;111(2):252–7.
  20. Nimsky C, Ganslandt O, Hofmann B, Fahlbusch R. Limited benefit of intraoperative low-field magnetic resonance imaging in craniopharyngioma surgery. Neurosurgery. 2003;53(1):72–80; discussion 80–1.
  21. Nimsky C, von Keller B, Ganslandt O, Fahlbusch R. Intraoperative high-field magnetic resonance imaging in transsphenoidal surgery of hormonally inactive pituitary macroadenomas. Neurosurgery. 2006;59(1):105–14; discussion 105–14.
  22. Berkmann S, Fandino J, Muller B, Remonda L, Landolt H. Intraoperative MRI and endocrinological outcome of transsphenoidal surgery for non-functioning pituitary adenoma. Acta Neurochir (Wien). 2012;154(4):639-47.
  23. Powell M. Recovery of vision following transsphenoidal surgery for pituitary adenomas. Br J Neurosurg. 1995;9:367–73.
  24. Cohen AR, Cooper PR, Kupersmith MJ, Flamm ES, Ransohoff J. Visual recovery after transsphenoidal removal of pituitary adenomas. Neurosurgery. 1985;17(3):446–52.
  25. Findlay G, McFadzean RM, Teasdale G. Recovery of vision following treatment of pituitary tumours; application of a new system of assessment to patients treated by transsphenoidal operation. Acta Neurochir (Wien). 1983;68(3–4):175–86.
  26. Harris PE, Afshar F, Coates P, Doniach I, Wass JA, Besser GM, et al. The effects of transsphenoidal surgery on endocrine function and visual fields in patients with functionless pituitary tumours. Q J Med. 1989;71(265):417–27.
  27. Laws ER Jr, Trautmann JC, Hollenhorst RW Jr. Transsphenoidal decompression of the optic nerve and chiasm. Visual results in 62 patients. J Neurosurg. 1977;46(6):717–22.
  28. Webb SM, Rigla M, Wagner A, Oliver B, Bartumeus F. Recovery of hypopituitarism after neurosurgical treatment of pituitary adenomas. J Clin Endocrinol Metab. 1999;84(10):3696–700.
  29. Barker FG, 2nd, Klibanski A, Swearingen B. Transsphenoidal surgery for pituitary tumors in the United States, 1996–2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab. 2003;88(10):4709–19.
  30. Comtois R, Beauregard H, Somma M, Serri O, Aris-Jilwan N, Hardy J. The clinical and endocrine outcome to trans-sphenoidal microsurgery of nonsecreting pituitary adenomas. Cancer. 1991;68(4):860–6.
  31. Nomikos P, Ladar C, Fahlbusch R, Buchfelder M. Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas – a study on 721 patients. Acta Neurochir (Wien). 2004;146(1):27–35.
  32. Colao A, Cerbone G, Cappabianca P, Ferone D, Alfieri A, Di Salle F, et al. Effect of surgery and radiotherapy on visual and endocrine function in nonfunctioning pituitary adenomas. J Endocrinol Invest. 1998;21(5):284–90.
  33. Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol. (Oxf) 1999;51(2):181–8.
  34. Semple PL, Webb MK, de Villiers JC, Laws ER Jr. Pituitary apoplexy. Neurosurgery. 2005;56(1):65–72; discussion 72–3.
  35. Melmed S. Medical progress: Acromegaly. N Engl J Med. 2006;355(24):2558–73.
  36. Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev. 2004;25(1):102–52.
  37. Dekkers OM, Biermasz NR, Pereira AM, Romijn JA, Vandenbroucke JP. Mortality in acromegaly: a metaanalysis. J Clin Endocrinol Metab. 2008;93(1):61–7.
  38. Freda PU, Wardlaw SL. Clinical review 110: Diagnosis and treatment of pituitary tumors. J Clin Endocrinol Metab. 1999;84(11):3859–66.
  39. Boscaro M, Arnaldi G. Approach to the patient with possible Cushing’s syndrome. J Clin Endocrinol Metab. 2009;94(9):3121–31.
  40. Jagannathan J, Sheehan JP, Jane JA Jr. Evaluation and management of Cushing syndrome in cases of negative sellar magnetic resonance imaging. Neurosurg Focus. 2007;23:E3.
  41. Kelly DF. Transsphenoidal surgery for Cushing’s disease: a review of success rates, remission predictors, management of failed surgery, and Nelson’s Syndrome. Neurosurg Focus. 2007;23:E5.
  42. Bochicchio D, Losa M, Buchfelder M. Factors influencing the immediate and late outcome of Cushing’s disease treated by transsphenoidal surgery: a retrospective study by the European Cushing’s Disease Survey Group. J Clin Endocrinol Metab. 1995;80(11):3114–20.
  43. Losa M, Mortini P, Barzaghi R, Gioia L, Giovanelli M. Surgical treatment of prolactin-secreting pituitary adenomas: early results and long-term outcome. J Clin Endocrinol Metab. 2002;87(7):3180–6.
  44. Serri O, Rasio E, Beauregard H, Hardy J, Somma M. Recurrence of hyperprolactinemia after selective transsphenoidal adenomectomy in women with prolactinoma. N Engl J Med. 1983;309(5):280–3.
  45. Tyrrell JB, Lamborn KR, Hannegan LT, Applebury CB, Wilson CB. Transsphenoidal microsurgical therapy of prolactinomas: initial outcomes and long-term results. Neurosurgery. 1999;44(2):254–61; discussion 61–3.
  46. Molitch MT, Thorner MO, Wilson C. Management of prolactinomas. J Clin Endocrinol Metab. 1997;82(4):996–1000.

Most read articles by the same author(s)

<< < 1 2