Surgery outcome of growth hormone-secreting pituitary adenoma with empty sella using a new classification

• Published in: World neurosurgery 2017
• Main Authors: Wang, Qiang, M.D, Guo, Xiaopeng, M.D, Gao, Lu, M.D, Wang, Zihao, M.D, Deng, Kan, M.D, Lian, Wei, M.D, Wang, Renzhi, M.D, Zhu, Huijuan, M.D, Xing, Bing, M.D
• Format: Article
• Language: English
• Subjects: Neurosurgery
• ISSN: 1878-8750
• DOI: 10.1016/j.wneu.2017.06.071

Abstract Objective To investigate the outcomes and identified risk factors for a cure and intraoperative cerebrospinal fluid leak following transsphenoidal surgery using a new classification for growth hormone-secreting pituitary adenoma associated with “empty sella”. Methods This retrospective cohort study included 51 patients enrolled from January 2010 to June 2016. All subjects were categorized into three groups using a new classification scheme: Grade A, whole tumor occupation area beneath a horizontal line drawn along the lowest level of ES; Grade B, tumor occupation area that crossed the horizontal line on one side; and Grade C, tumor occupation area that crossed the horizontal line on two sides. The clinical data were collected and analyzed. Results The cure rate for the Grade A patients (88.24%, 15/17) was significantly higher than those for the Grade B (55.00%, 11/20) and Grade C (50.00%, 7/14) patients. However, the occurrence of CSF leaks in the Grade C patients (35.71%, 5/14) was higher than in the Grade A patients (5.88%, 1/17). A logistic regression analysis indicated that the risk factors for cure included a large maximum tumor diameter ( P =0.009, OR=1.222), a high preoperative fasting GH level ( P =0.031, OR=1.088) and a high classification ( P =0.017, OR=4.485). The risk factor for an intraoperative CSF leak was a high classification ( P =0.039, OR=3.580). Conclusions Transsphenoidal surgery is the current optimal strategy for such co-existence; however, ES increases the difficulty of surgery with a higher incidence of complications. We found that the new classification scheme was better for predicting the surgery outcome for this disease.