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Peel-off resection of the pituitary gland for functional pituitary adenomas: pathological significance and impact on pituitary function
- Source :
- Pituitary. 22:507-513
- Publication Year :
- 2019
- Publisher :
- Springer Science and Business Media LLC, 2019.
-
Abstract
- Purpose: Functional pituitary adenomas (FPAs) lacking a well-defined pseudocapsule can invade the adjacent pituitary gland. In such situations, peel-off resection of the adjacent pituitary gland after selective adenomectomy might lead to complete tumor removal, resulting in optimal endocrinological outcomes. Here, we present the significance of peel-off resection of the pituitary gland in patients with FPA in whom complete extracapsular tumor removal cannot be achieved. Methods: We performed a retrospective review of 21 patients with FPA who underwent transsphenoidal surgery (TSS). After selective adenomectomy, peel-off resection of the adjacent pituitary gland was performed in 13 patients because complete extracapsular resection could not be achieved, while peel-off resection was not performed in the remaining 8 patients because complete extracapsular resection was accomplished. The clinical outcomes of these groups were compared. The pituitary tissues obtained by peel-off resection were pathologically examined for tumor cells. Results: Early postoperative biochemical remission was achieved in 20 patients (95.2%). Anterior pituitary functions were not aggravated postoperatively in any patient: however, transient diabetes insipidus (DI) occurred in 2 patients. There were no statistically significant differences in the clinical outcomes of the two groups. A pseudocapsule was pathologically detected in the adjacent anterior pituitary even in patients in whom no pseudocapsule was intraoperatively detected. Tumor cells were pathologically detected in 7 (58.3%) of 12 pituitary tissues examined. Conclusions: Peel-off resection of the pituitary gland, which can remove a small tumor cell remnant in the adjacent pituitary, might maximize the effectiveness of TSS with minimal impact on postoperative pituitary function.<br />ファイル公開:2020/10/01
- Subjects :
- Adenoma
Adult
Male
Pituitary gland
Pathology
medicine.medical_specialty
genetic structures
Pituitary Diseases
Endocrinology, Diabetes and Metabolism
medicine.medical_treatment
030209 endocrinology & metabolism
Neurosurgical Procedures
Resection
Pituitary resection
03 medical and health sciences
0302 clinical medicine
Endocrinology
Anterior pituitary
medicine
Humans
Pituitary Neoplasms
In patient
Pathological
Aged
Retrospective Studies
Aged, 80 and over
Transsphenoidal surgery
business.industry
Cushing disease
Middle Aged
medicine.disease
Pituitary adenoma
Pseudocapsule
Treatment Outcome
medicine.anatomical_structure
Pituitary Gland
Acromegaly
Diabetes insipidus
Female
Tumor removal
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 15737403 and 1386341X
- Volume :
- 22
- Database :
- OpenAIRE
- Journal :
- Pituitary
- Accession number :
- edsair.doi.dedup.....9578a790cae212bbb7d1ceb0d9575c69