Challenging Knosp high-grade pituitary adenomas

作者：Alexander Micko, Johannes Oberndorfer, Wolfgang J. Weninger, Greisa Vila, Romana Höftberger, Stefan Wolfsberger, Engelbert Knosp · 发表于：Journal of neurosurgery · 年份：2019 · DOI：10.3171/2019.3.jns19367 · 被引用次数：99 · 研究领域：Pituitary Gland Disorders and Treatments、Cerebrospinal fluid and hydrocephalus、Meningioma and schwannoma management

OBJECTIVE: Parasellar growth is one of the most important prognostic variables of pituitary adenoma surgery, with adenomas regarded as not completely resectable if they invade the cavernous sinus (CS) but potentially curable if they displace CS structures. This study was conducted to correlate surgical treatment options and outcomes to the different biological behaviors (invasion vs displacement) of adenomas with parasellar extension into the superior or inferior CS compartments or completely encasing the carotid artery (Knosp high grades 3A, 3B, and 4). METHODS: This was a retrospective cohort analysis of 106 consecutive patients with Knosp high-grade pituitary adenomas with parasellar extension who underwent surgery via a primary endoscopic transsphenoidal approach between 2003 and 2017. Biological tumor characteristics (surgical status of invasiveness and tumor texture, 2017 WHO classification, proliferation rate), extent of resection, and complication rate were correlated with parasellar extension grades 3A, 3B, and 4 on preoperative MRI studies. RESULTS: Invasiveness was significantly less common in grade 3A (44%) than in grade 3B (72%, p = 0.037) and grade 4 (100%, p < 0.001) adenomas. Fibrous tumor texture was significantly more common in grade 4 (52%) compared to grade 3A (20%, p = 0.002), but not compared to grade 3B (28%) adenomas. Functioning macroadenomas had a significantly higher rate of invasiveness than nonfunctioning adenomas (91% vs 55%, p = 0.002). Mean pro...