Recurrence Rates in Transnasal Transsphenoidal Surgeries for Gross Total Resection of Pituitary Adenoma Statistically Similar Regardless of the Extent of Pseudocapsule Dissection

Intro: Pituitary adenomas, benign neoplasms originating from the pituitary gland, comprise 10 to 15% of all primary brain tumors and pose a complex challenge to neurosurgeons due to their anatomical location within the sella turcica. Pseudocapsule dissection has emerged as a favorable approach in pituitary adenoma surgery, involving meticulous removal of the tumor tissue adherent to the histological pseudocapsule, a delicate layer that separates the adenoma from the normal pituitary gland. Recent studies have revealed the potential costs and benefits of complete pseudocapsule dissection in the management of pituitary adenomas, though the current data available remains relatively sparse. Some research has suggested that it may be associated with lower recurrence rates compared to alternative surgical approaches, though at the cost of slightly higher rates of intraoperative CSF leak and postoperative transient diabetes insipidus (DI). We sought to compare recurrence rate and time to recurrence in patients who received a gross total resection of their pituitary adenoma via TNTS using either complete pseudocapsule dissection, partial pseudocapsule dissection, or in cases where pseudocapsule dissection was not possible or not attempted.

Methods: This was a single institution, single surgeon retrospective chart review analyzing cases over 13 years (2009–2022). Inclusion criteria included diagnosis of pituitary adenoma, resection via TNTS, index surgery, gross total resection achieved, and at least 1 year follow-up available (imaging for nonfunctional tumors, imaging or labs for functional tumors). Time to recurrence between the three groups was displayed using KM survival curves and overall recurrence rate was compared using a chi square test.

Results: A total of 854 cases were available for review, of which 289 were included in final analysis. Ninety-seven patients (34%) received complete pseudocapsule dissection, 7 of which recurred (7/97, 7.2%). Eighty-nine patients (30.7%) received partial pseudocapsule dissection, 9 of which recurred (9/89, 10.1%). In 103 patients (35.6%), pseudocapsule dissection was not attempted or not possible, and the adenomas recurred in 9 of these patients (9/103, 8.7%). There was no significant difference in recurrence rate between the three groups (p = 0.78) or time to recurrence among the three groups (p = 0.42; [Fig. 1]).

Conclusion: In this cohort of patients, rate of recurrence and time to recurrence for adenomas was not impacted by extent of pseudocapsule dissection. Given the known increased risk of intraoperative CSF leak and transient DI in patients undergoing pseudocapsule dissection, these data suggest that this dissection technique may not be necessary to prevent recurrence in pituitary adenomas as long as gross total resection is achieved. Further subgroup analyses will examine these differences across functional vs nonfunctional tumors, as well as complication rates in these patients including CSF leak, DI, and postoperative endocrinopathy.

Fig. 1 Time to recurrence following gross total resection of pituitary adenoma.

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Artikel online veröffentlicht:
05. Februar 2024