Correlation of Pituitary Descent and Diabetes Insipidus After Transsphenoidal Pituitary Macroadenoma Resection.
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
01 06 2023
01 06 2023
Historique:
received:
08
08
2022
accepted:
10
11
2022
medline:
17
5
2023
pubmed:
27
1
2023
entrez:
26
1
2023
Statut:
ppublish
Résumé
Endoscopic transsphenoidal surgery remains the technique of choice for resection of pituitary adenoma. Postoperative diabetes insipidus (DI) is most often transient and observed in 1.6% to 34% of patients, whereas permanent DI has been reported in 0% to 2.7% of patients. The proposed mechanism was the transduction of traction forces exerted by the surgeon on the descended diaphragma sellae and through the pituitary stalk. To quantify and correlate the degree of pituitary gland descent with postoperative DI. Of 374 patients who underwent transsphenoidal resection of a pituitary adenoma between 2010 and 2020 at our institution, we report a cohort of 30 patients (Group A) DI. We also report a matched cohort by tumor volume of 30 patients who did not develop DI (Group B). We quantified the tension on the pituitary stalk by calculating pituitary descent interval (PDI) by comparing preoperative and postoperative position of the pituitary gland and using Pythagoras' formula where , with craniocaudal (CC) and anterior-posterior (AP) representing measurements of pituitary translation in respective directions after resection. Patients who developed DI had significantly greater pituitary gland translations in the craniocaudal (23.0 vs 16.3 mm, P = .0015) and anteroposterior (2.4 vs 1.5 mm, P = .0168) directions. Furthermore, Group A had a statistically greater PDI, which was associated with development of DI (23.2 vs 16.6 mm, P = .0017). We were able to quantify pituitary descent and subsequent tension on the pituitary stalk, while also associating it with development of postoperative DI after pituitary adenoma resection.
Sections du résumé
BACKGROUND
Endoscopic transsphenoidal surgery remains the technique of choice for resection of pituitary adenoma. Postoperative diabetes insipidus (DI) is most often transient and observed in 1.6% to 34% of patients, whereas permanent DI has been reported in 0% to 2.7% of patients. The proposed mechanism was the transduction of traction forces exerted by the surgeon on the descended diaphragma sellae and through the pituitary stalk.
OBJECTIVE
To quantify and correlate the degree of pituitary gland descent with postoperative DI.
METHODS
Of 374 patients who underwent transsphenoidal resection of a pituitary adenoma between 2010 and 2020 at our institution, we report a cohort of 30 patients (Group A) DI. We also report a matched cohort by tumor volume of 30 patients who did not develop DI (Group B). We quantified the tension on the pituitary stalk by calculating pituitary descent interval (PDI) by comparing preoperative and postoperative position of the pituitary gland and using Pythagoras' formula where , with craniocaudal (CC) and anterior-posterior (AP) representing measurements of pituitary translation in respective directions after resection.
RESULTS
Patients who developed DI had significantly greater pituitary gland translations in the craniocaudal (23.0 vs 16.3 mm, P = .0015) and anteroposterior (2.4 vs 1.5 mm, P = .0168) directions. Furthermore, Group A had a statistically greater PDI, which was associated with development of DI (23.2 vs 16.6 mm, P = .0017).
CONCLUSION
We were able to quantify pituitary descent and subsequent tension on the pituitary stalk, while also associating it with development of postoperative DI after pituitary adenoma resection.
Identifiants
pubmed: 36700759
doi: 10.1227/neu.0000000000002360
pii: 00006123-202306000-00020
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1269-1275Informations de copyright
Copyright © Congress of Neurological Surgeons 2023. All rights reserved.
Références
Fernandez A, Karavitaki N, Wass JAH. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol (Oxf). 2010;72(3):377-382.
Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A. High prevalence of pituitary adenomas: a cross-sectional study in the province of Liege, Belgium. J Clin Endocrinol Metab. 2006;91(12):4769-4775.
Ezzat S, Asa SL, Couldwell WT, et al. The prevalence of pituitary adenomas: a systematic review. Cancer. 2004;101(3):613-619.
Krings JG, Kallogjeri D, Wineland A, Nepple KG, Piccirillo JF, Getz AE. Complications following primary and revision transsphenoidal surgeries for pituitary tumors. Laryngoscope. 2015;125(2):311-317.
Sheehan JM, Sheehan JP, Douds GL, Page RB. DDAVP use in patients undergoing transsphenoidal surgery for pituitary adenomas. Acta Neurochir (Wien). 2006;148(3):287-291; discussion 291.
Black PM, Zervas NT, Candia GL. Incidence and management of complications of transsphenoidal operation for pituitary adenomas. Neurosurgery. 1987;20(6):920-924.
Sigounas DG, Sharpless JL, Cheng DML, Johnson TG, Senior BA, Ewend MG. Predictors and incidence of central diabetes insipidus after endoscopic pituitary surgery. Neurosurgery.;62(1):71-79; discussion 78-79.
Nemergut EC, Zuo Z, Jane JA, Laws ER. Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg. 2005;103(3):448-454.
Wilson DA, Duong H, Teo C, Kelly DF. The supraorbital endoscopic approach for tumors. World Neurosurg. 2014;82(6):S72-S80.
Hensen J, Henig A, Fahlbusch R, Meyer M, Boehnert M, Buchfelder M. Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas. Clin Endocrinol (Oxf). 1999;50(4):431-439.
Faltado AL, Macalalad-Josue AA, Li RJS, Quisumbing JPM, Yu MGY, Jimeno CA. Factors associated with postoperative diabetes insipidus after pituitary surgery. Endocrinol Metab (Seoul). 2017;32(4):426-433.
Guinto Balanzar G, Abdo M, Mercado M, Guinto P, Nishimura E, Arechiga N. Diaphragma sellae: a surgical reference for transsphenoidal resection of pituitary macroadenomas. World Neurosurg. 2011;75(2):286-293.
Capatina C, Paluzzi A, Mitchell R, Karavitaki N. Diabetes insipidus after traumatic brain injury. J Clin Med. 2015;4(7):1448-1462.
Schreckinger M, Szerlip N, Mittal S. Diabetes insipidus following resection of pituitary tumors. Clin Neurol Neurosurg. 2013;115(2):121-126.
Makarenko S, Ye V, Gooderham PA, Akagami R. A novel scale for describing visual outcomes in patients following resection of lesions affecting the optic apparatus: the Unified Visual Function Scale. J Neurosurg. 2018;129(6):1438-1445.
Ye V, Makarenko S, Gooderham PA, Akagami R. The unified visual function scale assessments show inter- and intraobserver agreement and correlate with patient quality of life in skull base parasellar tumors. J Neurol Surg B Skull Base. 2021;83(04):343-349.
Liu JK, Das K, Weiss MH, Laws ER, Couldwell WT. The history and evolution of transsphenoidal surgery. J Neurosurg. 2001;95(6):1083-1096.
Iglesias P, Rodríguez Berrocal V, Díez JJ. Giant pituitary adenoma: histological types, clinical features and therapeutic approaches. Endocrine. 2018;61(3):407-421.
Sinha S, Sharma BS. Giant pituitary adenomas—an enigma revisited. Microsurgical treatment strategies and outcome in a series of 250 patients. Br J Neurosurg. 2010;24(1):31-39.
Liu Y, Zheng T, Lv W, et al. Ambulatory surgery protocol for endoscopic endonasal resection of pituitary adenomas: a prospective single-arm trial with initial implementation experience. Sci Rep. 2020;10(1):9755.
Li K, Zhang J, Wang XS, Ye X, Zhao YL. A systematic review of effects and complications after transsphenoidal pituitary surgery: endoscopic versus microscopic approach. Minim Invasive Ther Allied Technol. 2020;29(6):317-325.
Hughes MA, Culpin E, Darley R, et al. Enhanced recovery and accelerated discharge after endoscopic transsphenoidal pituitary surgery: safety, patient feedback, and cost implications. Acta Neurochir (Wien). 2020;162(6):1281-1286.
Nadel J, Couldwell WT. Management of water and sodium disturbances after transsphenoidal resection of pituitary tumors. Neurol India. 2020;68(suppl):S101-S105.
Sarkiss CA, Lee J, Papin JA, et al. Pilot study on early postoperative discharge in pituitary adenoma patients: effect of socioeconomic factors and benefit of specialized pituitary centers. J Neurol Surg Part B Skull Base. 2015;76(4):323-330.
Thomas JG, Gadgil N, Samson SL, Takashima M, Yoshor D. Prospective trial of a short hospital stay protocol after endoscopic endonasal pituitary adenoma surgery. World Neurosurg. 2014;81(3-4):576-583.
Saborio P, Tipton GA, Chan JC. Diabetes insipidus. Pediatr Rev. 2000;21(4):122-129.
Loh JA, Verbalis JG. Disorders of water and salt metabolism associated with pituitary disease. Endocrinol Metab Clin North Am. 2008;37(1):213-234.
Hui C, Khan M, Radbel JM. Diabetes insipidus. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. Accessed December 4, 2021. http://www.ncbi.nlm.nih.gov/books/NBK470458/ .
Prete A, Corsello SM, Salvatori R. Current best practice in the management of patients after pituitary surgery. Ther Adv Endocrinol Metab. 2017;8(3):33-48.
Nozaki A, Ando T, Akazawa S, et al. Quality of life in the patients with central diabetes insipidus assessed by Nagasaki Diabetes Insipidus Questionnaire. Endocrine. 2016;51(1):140-147.
Behan LA, Sherlock M, Moyles P, et al. Abnormal plasma sodium concentrations in patients treated with desmopressin for cranial diabetes insipidus: results of a long-term retrospective study. Eur J Endocrinol. 2015;172(3):243-250.
McKee S, Yang A, Kidwai S, Govindaraj S, Shrivastava R, Iloreta A. The socioeconomic determinants for transsphenoidal pituitary surgery: a review of New York State from 1995 to 2015. Int Forum Allergy Rhinol. 2018;8(10):1145-1156.
Vimawala S, Chitguppi C, Reilly E, et al. Predicting prolonged length of stay after endoscopic transsphenoidal surgery for pituitary adenoma. Int Forum Allergy Rhinol. 2020;10(6):785-790.
Rizvi ZH, Ferrandino R, Luu Q, Suh JD, Wang MB. Nationwide analysis of unplanned 30-day readmissions after transsphenoidal pituitary surgery. Int Forum Allergy Rhinol. 2019;9(3):322-329.
Abdelmaksoud A, Fu P, Alwalid O, et al. Degrees of diaphragma sellae descent during transsphenoidal pituitary adenoma resection: predictive factors and effect on outcome. Curr Med Sci. 2018;38(5):888-893.
Schievink WI, Nuño M, Rozen TD, et al. Hyperprolactinemia due to spontaneous intracranial hypotension. J Neurosurg. 2015;122(5):1020-1025.