Prognosis of pituitary adenomas in the early 1970s and today—Is there a benefit of modern surgical techniques and treatment modalities?
Introduction
The development of new diagnostic modalities, surgical techniques and treatment strategies has changed the concept of pituitary adenoma therapy over the last 30 years remarkably. The computer tomographic (CT) scanning introduced by Hounsfield in 1973 [2], [24], [25], [26] and the magnetic resonance (MR) imaging in 1978 as described in detail by Doyle et al. in 1981 [17] represent the ‘gold standard’ methods for the diagnosis and follow up of intracranial tumors, in general. The use of the operating microscope has become a standard technique in most intracranial procedures since the 1960s [33], [56]. The microsurgical transsphenoidal approach was investigated and established over almost a century of research [32]. It used to represent the “gold standard” for surgical treatment of sellar lesions in the neurosurgical field [1], [11], [19], [23], [34]. However, further developments of endoscopic techniques and its applications in neurosurgery influenced also transnasal approaches [8], [20], [39], [40], [45], [50], [51], [52], [53], [57]. Continuous efforts to improve surgical techniques are still being made [3], [4], [5], [6], [7], [12], [30], [31]. Many publications on endonasal endoscopic surgery stress the less invasive nature of this technique, [35], [36], [38], [42], [43] providing a wider field of view. Additionally, angled telescopes allow inspection of retrocarotid, intracavernous and suprasellar space [42].
Although the mortality and morbidity rate in patients with gliomas [9], [44], meningiomas [37] and in those with brain abscesses [49] has been reduced in the last decades due to modern neurosurgical interventions, evidence of better prognosis for patients with pituitary adenomas is still lacking.
To evaluate the influence of the new modern diagnostic tools as well as new modern surgical techniques and approaches on the prognosis of patients with pituitary adenomas, the authors analysed patients who had surgical therapy for pituitary adenomas at their clinic in the years between 1963 and 2014 retrospectively.
Section snippets
Patient population
We performed a retrospective analysis on selected 277 patients [133 women and 144 men] operated at the department of Neurosurgery, at Saarland University between 1963 and 2014. The average age of the overall patient population was 51.2 years [SD ± 13.9 years].
Three groups of patients were selected according to the time interval, in which they were treated: we selected a first group of patients (group A) who was treated in the time period from 1963 until 1980. This collective was surgically treated
Overall results
A total of 93 patients met the inclusion criteria in group A (treated between 1963 and 1980), a total of 88 patients were included in group B (those treated between 1990 and 2000) and a total of 95 patients were included in group C (those treated between 2011 and 2014). In the first group, 52% (49/93) were of male and 48% (44/93) were of female gender. In the second group, 61% (54/88) were male and 39% (34/88) were female. In the third group, 42% (40/95) were male and 58% (55/95) were female.
Discussion
Although there have been notable technical advances in the surgical methods, including the development of new approaches to the sellar region and also in diagnostic modalities, including CT and MR imaging for diagnosis, as well as new intraoperative imaging tools and neuronavigation [10], [12], [14], [18], [23], [27], [29], [41], [46], [47], [55] in the last decades, the exact consequences of these new modalities on the prognosis and the recurrence free survival time in pituitary patients were
Conclusion
In conclusion, our study demonstrates that the prognosis of pituitary adenoma patients was improved by the introduction of new surgical approaches and techniques over the last decades. Clearly the perioperative morbidity and mortality rate has been reduced since the 1970s. In addition, even in initially successfully operated patients with pituitary adenomas a lifelong follow up period is necessary for the ultimate success of neurosurgical therapy.
Financial disclosure
J Oertel acts as consultant to Karl Storz Company. Besides this, the authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations,
Acknowledgement
We thank Prof. Dr. Jörg Rahnenführer, Faculty of Statistics of the University of Dortmund, Germany, for the partial support of our statistical analysis.
References (57)
- et al.
Imaging of the brain by nuclear magnetic resonance
Lancet
(1981) - et al.
Neurophysiologic monitoring in neurosurgery
Anesthesiol. Clin.
(2012) - et al.
Prognosis of meningiomas in the early 1970 and today
Clin. Neurol. Neurosurg.
(2016) - et al.
Endoscopic endonasal transclival resection of a brainstem cavernoma: a detailed account of our technique and comparison with the literature
World Neurosurg.
(2015) - et al.
CT-MR image data fusion for computer-assisted navigated surgery of orbital tumors
Eur. J. Radiol.
(2010) - et al.
The endoscopic endonasal transsphenoidal approach to sellar lesions allows a high radicality: the benefit of angled optics
Clin. Neurol. Neurosurg.
(2016) - et al.
Raising the bar in transsphenoidal pituitary surgery
World Neurosurg.
(2010) - et al.
Current modes of treatment of pituitary tumours
Br. J. Neurosurg.
(1993) Computerized x-ray scanning of the brain
J. Neurosurg.
(1974)- et al.
Endoscopic endonasal transsphenoidal surgery in recurrent and residual pituitary adenomas: technical note
Minim. Invasive Neurosurg.
(2000)