Journal of neuro-oncology · 2026
Pituitary adenomas associated with hydrocephalus: clinical characteristics, risk stratification, and clinical management.
СтатьяНазвание и аннотация: Перевод в очереди
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Zhou Wentao, Yu Man, Cheng Sen, Zhu Haibo, Cao Lei, Li Zhenye, Liu Chunhui, Bai Jiwei, Zhao Peng, Zhang Yazhuo, Gui Songbai, Li Chuzhong
Аннотация
OBJECTIVE: To characterize pituitary adenomas (PAs) complicated by hydrocephalus, identify factors associated with hydrocephalus occurrence and cerebrospinal fluid (CSF) diversion requirement, and develop a practical management framework.
METHODS: We retrospectively reviewed consecutive patients with histopathologically confirmed PAs who underwent endoscopic endonasal surgery between January 2020 and June 2024. Hydrocephalus was defined radiologically by an Evans' index > 0.30. Forty-five hydrocephalus cases were propensity score-matched 1:3 to 135 non-hydrocephalus controls. A temporally separated hydrocephalus cohort treated between July 2024 and March 2025 served as a validation cohort. Predictors of CSF diversion requirement and postoperative rescue diversion were evaluated using multivariable and exploratory pooled Firth logistic regression models.
RESULTS: Among 2,069 included patients, 45 (2.2%) had preoperative hydrocephalus. Compared with matched controls, the hydrocephalus cohort had greater tumor burden, more frequent suprasellar extension, longer operative time, greater blood loss, and a lower gross-total resection rate. Within the hydrocephalus cohort, the posterior extension phenotype (PE-positive) was the strongest preoperative structural correlate of CSF diversion requirement (OR 5.15, 95% CI 1.12-23.68), with AUCs of 0.809 in the training cohort and 0.845 in the temporal validation cohort. In exploratory pooled analyses, both PE-positive (OR 28.25, 95% CI 1.33-599.59) and intraoperative blood loss ≥ 800 mL (OR 15.94, 95% CI 1.78-143.00) were independently associated with postoperative rescue diversion.
CONCLUSION: Pituitary adenoma-associated hydrocephalus reflects increased perioperative complexity. The posterior extension phenotype and substantial intraoperative hemorrhagic burden identify higher-risk patients. Most can be managed with direct endoscopic endonasal resection without routine preoperative diversion.
METHODS: We retrospectively reviewed consecutive patients with histopathologically confirmed PAs who underwent endoscopic endonasal surgery between January 2020 and June 2024. Hydrocephalus was defined radiologically by an Evans' index > 0.30. Forty-five hydrocephalus cases were propensity score-matched 1:3 to 135 non-hydrocephalus controls. A temporally separated hydrocephalus cohort treated between July 2024 and March 2025 served as a validation cohort. Predictors of CSF diversion requirement and postoperative rescue diversion were evaluated using multivariable and exploratory pooled Firth logistic regression models.
RESULTS: Among 2,069 included patients, 45 (2.2%) had preoperative hydrocephalus. Compared with matched controls, the hydrocephalus cohort had greater tumor burden, more frequent suprasellar extension, longer operative time, greater blood loss, and a lower gross-total resection rate. Within the hydrocephalus cohort, the posterior extension phenotype (PE-positive) was the strongest preoperative structural correlate of CSF diversion requirement (OR 5.15, 95% CI 1.12-23.68), with AUCs of 0.809 in the training cohort and 0.845 in the temporal validation cohort. In exploratory pooled analyses, both PE-positive (OR 28.25, 95% CI 1.33-599.59) and intraoperative blood loss ≥ 800 mL (OR 15.94, 95% CI 1.78-143.00) were independently associated with postoperative rescue diversion.
CONCLUSION: Pituitary adenoma-associated hydrocephalus reflects increased perioperative complexity. The posterior extension phenotype and substantial intraoperative hemorrhagic burden identify higher-risk patients. Most can be managed with direct endoscopic endonasal resection without routine preoperative diversion.