World neurosurgery · 2026
Recurrent Pituitary Neuroendocrine Tumors: Anatomical Predictors of Gross-Total Resection with a Proposed Pituitary Resectability Score.
СтатьяНазвание и аннотация: Перевод в очереди
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Zohney Michael, Abd Elshafouk Mohamed Helmy, Aziz Mohamed M, Mohamed Ismail Mohamed Awad, El-Bahy Khaled
Аннотация
OBJECTIVE: Revision endoscopic endonasal transsphenoidal surgery (EETA) for recurrent pituitary neuroendocrine tumors (PitNET) is challenging due to altered anatomy and scarring. We prospectively evaluated extent of resection, clinical outcomes, and anatomical predictors of resectability, and assessed a proposed Pituitary Resectability Score (PRS).
METHODS: Thirty-two patients with recurrent or residual PitNET underwent EETA between January 2023 and June 2025. Extent of resection (EOR) was classified as gross-total, near-total, subtotal, or partial and correlated with anatomical characteristics using Fisher's exact test. A preoperatively assigned MRI-based PRS (cavernous sinus invasion, size, morphology, extrasellar extension) was evaluated against outcomes.
RESULTS: Mean age was 44±10 years; 66% were male. GTR was achieved in 44%, correlating with PRS class (91% Class I, 57% Class II, 0% Classes III-IV). Anatomical predictors - morphology, cavernous sinus invasion, size, and extrasellar extension - were significantly associated with EOR (all p<0.001). Intraoperative CSF leak occurred in 22% (3.1% requiring reoperation), transient diabetes insipidus in 13%, sinusitis in 19%, and sixth-nerve palsy in 3.1%, with no mortality. Visual improvement occurred in 76% of patients with preoperative deficits. At median 18-month follow-up, all patients receiving adjuvant radiosurgery or staged cranial surgery maintained stable tumor control.
CONCLUSION: Anatomical complexity, not recurrence status, determines resectability in recurrent PitNET. Tumor morphology, cavernous sinus invasion, size, and extrasellar extension were the principal limitations to GTR. The proposed PRS is a bedside-computable, MRI-based framework for structuring preoperative expectations about surgical goals. Multimodal management achieved stable control in this heterogeneously treated cohort. External validation remains necessary before adoption.
METHODS: Thirty-two patients with recurrent or residual PitNET underwent EETA between January 2023 and June 2025. Extent of resection (EOR) was classified as gross-total, near-total, subtotal, or partial and correlated with anatomical characteristics using Fisher's exact test. A preoperatively assigned MRI-based PRS (cavernous sinus invasion, size, morphology, extrasellar extension) was evaluated against outcomes.
RESULTS: Mean age was 44±10 years; 66% were male. GTR was achieved in 44%, correlating with PRS class (91% Class I, 57% Class II, 0% Classes III-IV). Anatomical predictors - morphology, cavernous sinus invasion, size, and extrasellar extension - were significantly associated with EOR (all p<0.001). Intraoperative CSF leak occurred in 22% (3.1% requiring reoperation), transient diabetes insipidus in 13%, sinusitis in 19%, and sixth-nerve palsy in 3.1%, with no mortality. Visual improvement occurred in 76% of patients with preoperative deficits. At median 18-month follow-up, all patients receiving adjuvant radiosurgery or staged cranial surgery maintained stable tumor control.
CONCLUSION: Anatomical complexity, not recurrence status, determines resectability in recurrent PitNET. Tumor morphology, cavernous sinus invasion, size, and extrasellar extension were the principal limitations to GTR. The proposed PRS is a bedside-computable, MRI-based framework for structuring preoperative expectations about surgical goals. Multimodal management achieved stable control in this heterogeneously treated cohort. External validation remains necessary before adoption.