of Microsurgical Sublabial Approach (MSA) Versus Endoscopic Endonasal Approach (EEA) for the Treatment of Pituitary Adenomas Based on Radiological and Hormonal Outcome

Fig. 1

The Fig. shows the endoscopic endonasal approach (EEA) subgroups in terms of hormonal secretion: there were 41 nonsecreting adenomas, and 3 adrenocorticotropic hormone (ACTH), 1 thyroid stimulating hormone (TSH), 10 prolactin (PRL), and 17 growth hormone (GH) adenomas

Fig. 2

The Fig. shows the microsurgical sublabial approach (MSA) subgroups, in terms of hormonal secretion: there were 20 nonsecreting adenomas, and 7 ACTH, 6 PRL, and 9 GH adenomas

Different preoperative parameters were evaluated: type of lesion (secreting vs. nonsecreting adenoma), size (macroadenoma > 1 cm vs. microadenoma ≤ 1 cm), presence of intralesional hemorrhage, the perimeter of the lesion (nodular vs. uniform), intrasellar lesion vs. suprasellar lesion, and involvement of the cavernous sinus (no vs. yes). For the invasion of the cavernous sinus, we used the Knosp scale: grade ≥2 has been considered suggestive of invasion [22]. Osteodural invasion was evaluated during surgery. Preoperative clinical and laboratory diagnosis was confirmed by tissue histological examination (Table 1). Each of the 114 patients included in our test set were followed-up with pituitary MRI with dynamic contrast-enhancement sequences performed at 3, 6, and 12 months after surgery, and for those with secreting adenomas, a postoperative hormonal assay was performed 12 months after the surgery.

Table 1

Summary of all characteristics of adenomas included in the study

	EEA	MSA
Micro	7	18
Macro	65	24
Secreting	31	22
Nonsecreting	41	20
Infiltrative	36	10
Noninfiltrative	36	32
Hemorrhagic	11	2
Nonhemorrhagic	61	40
Uniform	41	35
Nodular	31	7
Intrasellar	14	23
Suprasellar	58	19
CS invasion	41	7
No CS invasion	31	35

CS Cavernous Sinus, EEA endoscopic endonasal approach, MSA microsurgical sublabial approach

Statistical evaluation of the collected data was performed using the χ ² test and Fisher test, in order to elaborate univariate and multivariate analyses with contingency tables.

Regarding hormonal secretion, the efficacy of the two surgical procedures was assessed in two main secreting subgroups, GH (18 EEA and 9 MSA) and PRL (9 EEA and 6 MSA). We considered patients to be healed when normalization was shown (GH: < 1 ng/ml, insulin-like growth factor 1 [IGF1] < 300 ng/ml; PRL: < 20 ng/ml) at 12-month hormonal essays, compared with the preoperative data.

Results

On preliminary analysis performed in the two groups, MSA seemed to be more effective than EEA (76.2 % vs. 47.2 %, p < 0.01) (Table 2).

Table 2

Total number of patients treated with EEA and MSA

	Total removal	Partial removal	p (χ ²)
EEA	34	38
MSA	32	10	<0.01

MSA was significantly more effective than EEA (p < 0.01)

Considering the hormonal activity (secreting or nonsecreting) a significantly greater efficacy of MSA was evidenced in the removal of secreting adenomas: 90.9 % of patients affected by a secreting adenoma were successfully treated using the sublabial approach, vs. 48.3 % of patients operated on with endoscopy (χ ² test, p <0.01) (Table 3). The sublabial technique was also more effective in the treatment of microadenomas, with 100 % of “sublabial” patients vs. 57.1 % of “endoscopic” patients healed (Fisher test, p <0.05) (Table 3). In noninfiltrating adenomas too, we documented better efficacy of MSA: 87.5 % sublabial vs. 55.5 % endoscopic (χ ² test, p <0.01) (Table 3), and similar results were detected in the nonhemorrhagic adenomas, with efficacy of 45.9 % for EEA vs. 75 % for MSA (χ ² test, p <0.01) (Table 3). Considering the main subgroups of secreting adenomas—GH and PRL—greater efficacy of MSA was documented for GH adenomas (88.8 % vs. 43.7 %, Fisher test, p < 0.05), while for the PRL adenomas the differences between the two techniques were not statistically relevant (Table 4).

Table 3

Univariate significance data

	EEA		MSA		p (χ ² or Fisher test)
	Total removal	Partial removal	Total removal	Partial removal	p (χ ² or Fisher test)
Secreting	15	16	20	2	p < 0.01 (χ ²)
Microadenoma	4	3	18	0	p < 0.05 (Fisher)
Noninfiltrative	20	16	28	4	p < 0.01 (χ ²)
Nonhemorrhagic	28	33	30	10	p < 0.01 (χ ²)

MSA was more effective than EEA in the treatment of the secreting, microadenoma, noninfiltrative adenoma, and nonhemorrhagic adenoma groups

Table 4

Hormonal normalization after 12 months for GH- and PRL-secreting adenomas

	EEA		MSA		p (Fisher test)
	Normalization (12-month follow-up)		Normalization (12-month follow-up)
	Yes	No	Yes	No
GH-secreting	7	11	8	1	p < 0.05*
PRL-secreting	6	3	4 Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: Junction Transanasal and Transoral Approaches: Reconstruct the Surgical Pathways with Soft or Hard Tissue Endocopic Lines? This Is the Question CHAPTER: Anterior Cervical Discectomy and Fusion with a Compressive C-JAWS Staple and Neuropsychological Outcome After Microsurgical and Endovascular Treatment of Ruptured and Unruptured Anterior Communicating Artery Aneurysms: A Single-Enter Experience Disk Herniation Treatment with Surgical Exploration by Unilateral Intertransversarii Microsurgical Approach of Vertebral Body After Radiofrequency Ablation and Augmentation in Dorsolumbar Metastatic Vertebral Fracture: Analysis of Clinical and Radiological Outcome in a Clinical Series of 18 Patients of High-Resolution Ultrasonography in Anterior Subcutaneous Transposition of the Ulnar Nerve for Cubital Tunnel Syndrome Stay updated, free articles. Join our Telegram channel Tags: Trends in Reconstructive Neurosurgery Jun 24, 2017 \| Posted by admin in NEUROSURGERY \| Comments Off on of Microsurgical Sublabial Approach (MSA) Versus Endoscopic Endonasal Approach (EEA) for the Treatment of Pituitary Adenomas Based on Radiological and Hormonal Outcome Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access