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Pituitary. 2015 Dec;18(6):868-75. doi: 10.1007/s11102-015-0664-3.

Impact of selective pituitary gland incision or resection on hormonal function after adenoma or cyst resection.

Author information

1
Pacific Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA, USA. barkhoudariang@jwci.org.
2
Inland Neurosurgery Institute, Pomona, CA, USA.
3
Wayne State Medical School, Detroit, MI, USA.
4
Pacific Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA, USA.

Abstract

OBJECTIVE:

With the resection of pituitary lesions, the anterior pituitary gland often obstructs transsphenoidal access to the lesion. In such cases, a gland incision and/or partial gland resection may be required to obtain adequate exposure. We investigate this technique and determine the associated risk of post-operative hypopituitarism.

METHODS:

All patients who underwent surgical resection of a pituitary adenoma or Rathke cleft cyst (RCC) between July 2007 and January 2013 were analyzed for pre- and post-operative hormone function. The cohort of patients with gland incision/resection were compared to a case-matched control cohort of pituitary surgery patients. Total hypophysectomy patients were excluded from outcome analysis.

RESULTS:

Of 372 operations over this period, an anterior pituitary gland incision or partial gland resection was performed in 79 cases (21.2 %). These include 53 gland incisions, 12 partial hemi-hypophysectomies and 14 resections of thinned/attenuated anterior gland. Diagnoses included 64 adenomas and 15 RCCs. New permanent hypopituitarism occurred in three patients (3.8 %), including permanent DI (3) and growth hormone deficiency (1). There was no significant difference in the rate of worsening gland dysfunction nor gain of function. Compared to a control cohort, there was a significantly lower incidence of transient DI (1.25 vs. 11.1 %, p = 0.009) but no significant difference in permanent DI (3.8 vs. 4.0 %) in the gland incision group.

CONCLUSION:

Selective gland incisions and gland resections were performed in over 20 % of our cases. This technique appears to minimize traction on compressed normal pituitary gland during removal of large lesions and facilitates better visualization and removal of cysts, microadenomas and macroadenomas.

KEYWORDS:

Diabetes insipidus; Hypopituitarism; Pituitary adenoma; Rathke cleft cyst; Transsphenoidal surgery

PMID:
26115709
DOI:
10.1007/s11102-015-0664-3
[Indexed for MEDLINE]

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