• World Neurosurg · Jan 2019

    Comparison of endoscopic vs microsurgical resection of pituitary adenomas with parasellar extension and evaluation of the predictive value of a simple "4 quadrants" radiological classification.

    • Gianluca Trevisi, Vera Vigo, Maria Grazia Morena, Domenico Luca Grieco, Mario Rigante, Carmelo Anile, and Annunziato Mangiola.
    • Department of Neurosurgery, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
    • World Neurosurg. 2019 Jan 1; 121: e769-e774.

    BackgroundThe amount of parasellar extension is a known limitation for gross total resection (GTR) of pituitary adenomas. Endoscopic technique seems to improve resection of adenomas extending laterally. Knosp classification is used to evaluate the extent of parasellar invasion: increasing Knosp grades correspond with lower rates of GTR. The 4-quadrant method could help to estimate the risk of partial resection in adenomas with parasellar extension. The objective of this study was to compare the rate of GTR between microsurgical and endoscopic techniques in pituitary adenomas with parasellar extension. The secondary aim was to compare the predictive value of Knosp classification and of the 4-quadrant classification regarding GTR.MethodsThis was a retrospective comparison of GTR in different Knosp grades and per quadrant in 55 consecutive patients who underwent microsurgical (n = 28, 2001-2008) or endoscopic (n = 27, 2008-2016) resection of a pituitary adenoma with parasellar extension.ResultsThe endoscopic group (19/27 patients) had a significant higher rate of GTR than the microsurgical group (8/28 patients) (P = 0.005). This was evident in all patients but those with Knosp grade 4. Using the quadrant classification, the endoscopic group had a significantly higher rate of GTR than the microsurgical group in all but the inferolateral quadrant. The 2 classifications showed similar sensitivity in predicting subtotal resection (78% quadrant vs. 82% Knosp), with limited specificity (both 25%).ConclusionsGTR of macroadenomas with parasellar extension is significantly enhanced by the endoscopic approach. The 4-quadrant classification appears as sensitive as the Knosp classification and could be a simple adjunct to predict surgical radicality, in particular in cases of inferolateral quadrant invasion.Copyright © 2018 Elsevier Inc. All rights reserved.

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