AB031. Endoscopic transsphenoidal surgery for functional pituitary adenoma: shifting paradigms towards pseudocapsule-based resection
Abstract

AB031. Endoscopic transsphenoidal surgery for functional pituitary adenoma: shifting paradigms towards pseudocapsule-based resection

Wei Ping Ng1, King Peng Lee1, Komathi Ramachandran2, Azmi Alias1, Subashini Rajoo3

1Department of Neurosurgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 2Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Putrajaya, Putrajaya, Malaysia; 3Department of Medicine, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia

Correspondence to: Wei Ping Ng, MD. Department of Neurosurgery, Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia. Email: weipingng@yahoo.com.

Background: Functional pituitary adenomas (PAs) manifest as intricate clinical syndromes, and surgery emerges as the principal intervention to mitigate associated morbidity and mortality. The endoscopic transsphenoidal surgery (ETS) approach stands as the preferred method for addressing PAs, with postoperative remission acting as a pivotal prognostic factor.

Methods: This study seeks to evaluate the influence of different surgical techniques and complications of ETS on functional PAs, focusing on both Acromegaly and Cushing’s disease (CD). Patient records, including characteristics, perioperative assessments, postoperative complications, and follow-up data, were systematically gathered. Tumor resection methods were categorized into: (I) complete pseudocapsule resection; and (II) complete piecemeal resection. Post-surgery, daily monitoring of serum cortisol levels continued for a consecutive 3-day period until values of 2 µg/dL or less were achieved. Growth hormone levels were reassessed 12 weeks later, targeting a level of <0.14 g/L. A follow-up enhanced magnetic resonance imaging examination was conducted 3 months post-surgery to confirm the absence of residual tumors.

Results: The study identified 46 patients (23 with acromegaly and 13 with CD) who underwent endoscopic surgery between 2020 and 2023. Twenty-six patients underwent piecemeal resection (January 2020 to December 2022), while 10 patients underwent complete pseudocapsule removal (January to December 2023). No significant changes in surgical complications were observed between the two techniques. No instances of carotid artery injury, epistaxis, intracranial infection, or loss of olfaction were reported. In the pseudocapsule group, one patient experienced transient vision loss. Notably, 80% of patients in the pseudocapsule group achieved remission as compared to 57.7% in the piecemeal group.

Conclusions: Pseudocapsule-based resection exhibited a remarkable remission rate, a low complication rate, and an absence of recurrence in functional adenoma patients. Despite the limited number of cases and our early experience, further studies are warranted to validate its effectiveness and safety.

Keywords: Endoscopic transsphenoidal surgery (ETS); pseudocapsule; pituitary adenoma (PA); acromegaly; Cushing’s disease (CD)

Acknowledgments

The authors thank all the efforts provided by Hospital Kuala Lumpur, Malaysia and Otorhinolaryngology Team from Hospital Putrajaya, Malaysia.

Funding: None.

Footnote

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cco.amegroups.com/article/view/10.21037/cco-24-ab031/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the Helsinki Declaration (as revised in 2013). Written informed consent was obtained from the patient’s parents for publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the noncommercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

Cite this abstract as: Ng WP, Lee KP, Ramachandran K, Alias A, Rajoo S. AB031. Endoscopic transsphenoidal surgery for functional pituitary adenoma: shifting paradigms towards pseudocapsule-based resection. Chin Clin Oncol 2024;13(Suppl 1):AB031. doi: 10.21037/cco-24-ab031

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