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Anterior-posterior diameter is a key driver of resectability and complications for pituitary adenomas with suprasellar extension in endoscopic transsphenoidal surgery

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Abstract

Background

As endoscopic transsphenoidal approaches are more routinely selected for progressively larger pituitary adenomas with parasellar extension, understanding potential anatomical factors that limit resection and contribute to complications is becoming increasingly important for tailoring a surgical approach. This study aimed to reevaluate existing predictive tools for resectability in pituitary adenomas specifically with suprasellar extension, and furthermore identify any additional measurable features that may be more useful in preoperative planning.

Methods

A single-center retrospective chart review of adult patients who underwent endoscopic transsphenoidal surgery for pituitary adenomas with suprasellar extension from 2015 to 2020 was performed. Preoperative MRIs were systematically assessed to assign a Knosp classification, a Zurich Pituitary Score (ZPS), and for dimensional measurements of the suprasellar aspect of the lesions. Univariate comparisons and multivariate regression models were employed to assess the influence of these factors on extent of resection and postoperative complications.

Results

Of the 96 patients with suprasellar pituitary adenomas who underwent endoscopic transsphenoidal surgery, 74 patients (77%) had a gross total resection (GTR). Neither Knosp grade nor ZPS score, even when dichotomized, demonstrated an association with GTR (Knosp 3A-4 versus Knosp 0–2, p = 0.069; ZPS III-IV versus ZPS I-II, p = 0.079). Multivariate regression analysis identified suprasellar anterior-posterior tumor diameter (SSAP) as the only significant predictor of extent of resection in this cohort (OR 0.951, 95% CI 0.905-1.000, p = 0.048*). A higher SSAP also had the strongest association with intraoperative CSF leaks (p = 0.0012*) and an increased overall rate of postoperative complications (p = 0.002*). Further analysis of the regression model for GTR suggested an optimal cut point value for SSAP of 23.7 mm, above which predictability for failing to achieve GTR carried a sensitivity of 89% and a specificity of 41%.

Conclusions

This study is unique in its examination of endoscopic transsphenoidal surgical outcomes for pituitary adenomas with suprasellar extension. Our findings suggest that previously established grading systems based on lateral extension into the cavernous sinus lose their predictive value in lesions with suprasellar extension and, more specifically, with increasing suprasellar anterior-posterior diameter.

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Acknowledgements

The authors would like to acknowledge Dr. Michael Schulder, Dr. Mark Chaskes, Dr. Margherita Bruni, and Dr. Griffin Baum for their support of the trainees who put together this article and for their overall guidance in the publication process.

Funding

This work received no funding, sponsorship, or other material supplementation.

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Author notes

  1. Jung Park and Danielle Golub are co-primary authors

Authors and Affiliations

  1. Department of Neurosurgery, Northwell Health, Manhasset, NY, USA

    Jung Park, Danielle Golub, Timothy G. White, Eric T. Quach, Kaiyun Yang, Mark B. Eisenberg & Amir R. Dehdashti

  2. Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA

    Marianne Ruelle & Harshal A. Shah

  3. Department of Otolaryngology-Head and Neck Surgery, Northwell Health, Manhasset, NY, USA

    Judd H. Fastenberg

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Contributions

Manuscript drafting and revision (DG, JP, TW, EQ, HS, AD); Clinical data collection and interpretation (TW, MR, HS, DG, ME, AD); Figure design (DG, JP, EQ, KY, JF); Manuscript editing and revision (JP, EQ, KY, JF, ME, AD); Literature review (DG, JP); Research team management and oversight (JF, ME, AD). All authors reviewed the final version of the manuscript for submission.

Corresponding author

Correspondence to Danielle Golub.

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Competing interests

The authors declare no competing interests.

Ethical approval

Institutional Review Board (IRB) approval for this single-center retrospective chart review study to review individual patient charts for data capture was obtained by the lead author under the guidelines set forth by the Northwell Health Human Research Protection Program. Given the retrospective nature of the research and supervised anonymization process for data collection under IRB guidelines, individual patient consent to participate and consent to publish were not required.

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Park, J., Golub, D., White, T.G. et al. Anterior-posterior diameter is a key driver of resectability and complications for pituitary adenomas with suprasellar extension in endoscopic transsphenoidal surgery. Pituitary 26, 629–641 (2023). https://doi.org/10.1007/s11102-023-01354-z

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