98 Views

Endoscopic Endonasal Approach for Nonfunctional Pituitary Adenomas: Comprehensive Long-Term Outcomes in 326 Consecutive Cases at a Tertiary Academic Center

Friday, May 3, 2024

Presenting Author(s)

Zachary C. Gersey, MD

Resident
University of Pittsburgh Medical Center Department of Neurosurgery
Pittsburgh, PA, US

Co-Author(s)

HA

Hussein Abdallah, MD

resident
UPMC
Pittsburgh, Pennsylvania, United States
Hussam Abou-Al-Shaar, MD

resident
UPMC
Pittsburgh, Pennsylvania, United States
KA

Keerthi Arani, MD

Attending Radiology
University of Pittsburgh Medical Center, Department of Radiology, United States
GB

Gabriella Bonhomme, MD

Attending Ophthalmology
University of Pittsburgh Medical Center, Department of Ophthalmology, United States
PF

Pouneh Fazeli, MD

attending
UPMC endocrinology, United States
Paul A. Gardner, MD

Neurosurgeon
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
ZG

Zane Gray, BS

student
University of Pittsburgh, United States
HM

Hussain Mahmud, MD

Attending Endocrinology
UPMC endocrinology, United States
Tritan J. Plute, BS

Student
University of Pittsburgh
Pittsburgh, Pennsylvania, United States
CS

Carl Snyderman, MD MBA

Professor of Otolaryngology and Neurological Surgery
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States
SS

Susan Stefko, MD

Attending Ophthalmology
University of Pittsburgh Medical Center, Department of Ophthalmology, United States
EW

Eric Wang, MD

Attending Otolaryngology
UPMC Otolaryngology, United States
Georgios A. Zenonos, MD (he/him/his)

Attending Neurosurgeon
UPMC Neurosurgery
PIttsburgh, Pennsylvania, United States

Introduction: We describe the clinical and pathological characteristics of Nonfunctional pituitary adenomas (NFPAs) treated by EEA and report on the multisystem manifestations of the disease and outcomes after surgery.

Methods: 1165 NFPAs treated by the EEA at a tertiary academic medical center between 2007-2021 were retrospectively screened and included if the adenoma was nonfunctional and patients received at least two years of post-operative surveillance MRI.

Results: 326 cases of NFPAs were included and followed for a median duration of 59 months. The median tumor volume was 4.6 cc and 30% of tumors were Knosp grade 3-4. In multivariable analysis, age (OR = 0.95, p = 0.010) and craniocaudal tumor size (OR = 1.08, p = 0.006) were significantly associated with recovery of vision. Complications included one permanent CN III palsy (0.4%), 2 carotid injuries (0.62%), and 13 CSF leaks (4%) repaired with revision EEA. The factors associated with gross-total resection were year of treatment (center experience) (OR = 1.25, p < 0.001), redo surgery (OR = 0.15, p < 0.001), tumor volume (OR = 0.99, p = 0.007), 3rd ventricle invasion (OR = 0.26, p = 0.026), and grade 4 Knosp tumors (OR = 0.12, p = 0.006). Over the years studied, 55 patients (18%) experienced tumor recurrence after a median of 3.7 years (IQR 2.0-6.2). The 5-year progression free survival was 91% for patients receiving GTR versus 71% for those receiving subtotal resection (p < 0.001), however the difference was insignificant (p = 0.797) if patients received adjuvant radiation following subtotal resection (5-year PFS of 82%). The independent factors associated with tumor recurrence were age (HR = 0.97, p = 0.011), tumor proliferation rate (Ki-67%) (HR = 1.18, p = 0.014), Knosp 4 grade (HR = 9.14, p = 0.011), and GTR (HR = 0.42, p = 0.006).

Conclusion : The EEA is a highly safe and effective approach for NFPA at experienced centers.