E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Endoscopic Transsphenoidal Surgery Outcomes in PitNETs with Suprasellar Extension: Assessment of Residual Tumor Descent into the Sella
Osman TANRIVERDİ✉ ,
Buruç ERKAN ,
Ebubekir AKPINAR ,
Gökhan CANAZ ,
Ozan HAŞİMOĞLU ,
Ozan BARUT ,
Barış ÇÖLLÜOĞLU ,
Suat DEMİR ,
Kübra GEZİCİ ,
Ömür GÜNALDI
DOI: 10.5137/1019-5149.JTN.48719-25.0
Article in Press
Corresponding Author:
Osman TANRIVERDİ (osmantanriverdi74@gmail.com)
Abstract
Aim
This study evaluates the impact of suprasellar extension (SSE) morphology and radiological parameters on surgical outcomes and the descent of suprasellar residual tumors into the sella at three months postoperatively in pituitary neuroendocrine tumors (PitNETs) with SSE.
Material and Methods
A retrospective analysis of 153 PitNET patients with SSE ≥5 mm who underwent endoscopic endonasal transsphenoidal surgery (EETPS) between July 2020 and April 2024 was performed. SSE was classified into four grades (I: 510 mm, II: 1020 mm, III: 2030 mm, IV: >30 mm). Tumor morphology was assessed using the vertical height (H value) of the superior PitNET surface relative to a nasal-tuberculum reference line and the x/y ratio (longest suprasellar tumor diameter/supraclinoid intercarotid distance). Residual tumor descent at three months was categorized as complete (Group A), partial (Group B), or absent (Group C).
Results
The gross total resection (GTR) rate was 55%, decreasing with increasing SSE (p<0.001). Lower GTR was significantly associated with anterior cranial fossa, prepontine cistern, third ventricle, and hypothalamic extension, lateral SSE, dumbbell/multilobular morphology, and a higher x/y ratio (p<0.05). At three months, 45% of residuals fully descended, 40% partially descended, and 15% remained. Impaired descent correlated with anterior cranial fossa, third ventricle, and hypothalamic extension, lateral SSE, dumbbell/multilobular morphology, increased H value, larger tumor size, and a higher x/y ratio (p<0.05). Complications included rhinorrhea (4.5%) and residual tumor hemorrhage (3.2%), with a 2% mortality rate.
Conclusion
In PitNETs with SSE, accurate preoperative radiological assessment and proper classification of SSE morphology are crucial for surgical planning. Although EETPS is an effective treatment option, the dynamics of suprasellar residual tumor descent into the sella may influence decisions regarding a second EETPS and/or transcranial surgery.
This study evaluates the impact of suprasellar extension (SSE) morphology and radiological parameters on surgical outcomes and the descent of suprasellar residual tumors into the sella at three months postoperatively in pituitary neuroendocrine tumors (PitNETs) with SSE.
Material and Methods
A retrospective analysis of 153 PitNET patients with SSE ≥5 mm who underwent endoscopic endonasal transsphenoidal surgery (EETPS) between July 2020 and April 2024 was performed. SSE was classified into four grades (I: 510 mm, II: 1020 mm, III: 2030 mm, IV: >30 mm). Tumor morphology was assessed using the vertical height (H value) of the superior PitNET surface relative to a nasal-tuberculum reference line and the x/y ratio (longest suprasellar tumor diameter/supraclinoid intercarotid distance). Residual tumor descent at three months was categorized as complete (Group A), partial (Group B), or absent (Group C).
Results
The gross total resection (GTR) rate was 55%, decreasing with increasing SSE (p<0.001). Lower GTR was significantly associated with anterior cranial fossa, prepontine cistern, third ventricle, and hypothalamic extension, lateral SSE, dumbbell/multilobular morphology, and a higher x/y ratio (p<0.05). At three months, 45% of residuals fully descended, 40% partially descended, and 15% remained. Impaired descent correlated with anterior cranial fossa, third ventricle, and hypothalamic extension, lateral SSE, dumbbell/multilobular morphology, increased H value, larger tumor size, and a higher x/y ratio (p<0.05). Complications included rhinorrhea (4.5%) and residual tumor hemorrhage (3.2%), with a 2% mortality rate.
Conclusion
In PitNETs with SSE, accurate preoperative radiological assessment and proper classification of SSE morphology are crucial for surgical planning. Although EETPS is an effective treatment option, the dynamics of suprasellar residual tumor descent into the sella may influence decisions regarding a second EETPS and/or transcranial surgery.
Keywords
Descending adenoma
Endoscopic surgery
Gross total resection
Macroadenoma
Pituitary adenoma