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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
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Extra-Pseudocapsular Transsphenoidal Surgery for Microprolactinoma in Women
Juan Chen1,2, Xiang Guo1,2, Zhuangzhuang Miao1,2
1Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Journal of Clinical Medicine
|July 9, 2022
Summary
Extra-pseudocapsular transsphenoidal surgery (EPTSS) offers high remission rates for young women with microprolactinomas. This approach shows promise as a primary treatment, especially for tumors with a pseudocapsule and specific pituitary positions.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Prolactinomas are common pituitary tumors, often treated with dopamine agonists.
- Transsphenoidal surgery (TSS) is an alternative, with extra-pseudocapsular dissection (EPTSS) gaining attention.
- Histological pseudocapsule (PS) presence and tumor-pituitary relationship are key factors in surgical outcomes.
Purpose of the Study:
- To evaluate the effectiveness and risks of EPTSS for young women with microprolactinoma.
- To identify factors influencing remission and recurrence after EPTSS.
- To explore shifting indications for primary TSS in prolactinoma treatment.
Main Methods:
- Retrospective analysis of 133 premenopausal women with microprolactinoma (≤10 mm) undergoing EPTSS.
- Intraoperative identification of pseudocapsule (PS).
- Classification of tumors based on position relative to the pituitary (hypo-, para-, supra-pituitary).
Main Results:
- Pseudocapsule (PS) identified in 84.96% of microadenomas.
- Long-term surgical cure rate of 88.2%; comprehensive remission rate of 95.8%.
- Low surgical morbidity (4.5%) with no severe complications. Recurrence rate was 9.2% over 5 years, significantly lower in complete PS and hypo-pituitary groups.
Conclusions:
- EPTSS is effective and safe for young women with microprolactinoma, increasing remission rates without significant risks.
- First-line EPTSS may be indicated for hypo-pituitary microprolactinomas (Knosp grade 0-II) for better long-term cure potential.
- Tumor pseudocapsule and position are crucial factors for predicting surgical success and recurrence in prolactinoma treatment.
