Archives of endocrinology and metabolism · 2026
Prognostic factors in the surgical treatment of non-functioning pituitary adenomas: a retrospective cohort study.
СтатьяНазвание и аннотация: Перевод в очереди
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Aquno Ana Clara Toschi, Salgado João Lucas Gomes, Borgatto Lucas Dos Santos, Hamamoto Filho Pedro Tadao, Tagliarini José Vicente, Zanini Marco Antonio, Nogueira Vania Dos Santos Nunes, Yacubian-Fernandes Adriano
Аннотация
OBJECTIVE: This study aimed to analyze preoperative, intraoperative, and postoperative factors that affect the surgical prognosis of non-functioning pituitary adenomas (NFPA) and to determine postoperative complication rates.
MATERIALS AND METHODS: We conducted a retrospective cohort study of patients with NFPA who underwent surgery between 1995 and 2024 at a tertiary public hospital in Brazil. Variables analyzed included tumor size, cavernous sinus invasion (Knosp classification), endocrinological status, preoperative clinical features, surgical complications, and outcomes. Statistical significance was set at p ≤ 0.05.
RESULTS: Seventy-three patients were included, with a mean age of 53 years and a slight predominance of females. Tumors were classified as macroadenomas (59%) and giant adenomas (41%). The transsphenoidal approach was used in 81% of cases. Partial resection was achieved in 56%, subtotal in 16%, and total in 27%. Immediate postoperative complications included diabetes insipidus (30%), bleeding (11%), hydrocephalus (10%), ischemia (10%), meningitis (6%), and cerebrospinal fluid fistula (11%). Mortality was 9.6%, significantly associated with postoperative hydrocephalus, ischemia, and larger tumor size. Giant tumors were correlated with higher rates of preoperative neurological deficits and postoperative complications. Transcranial surgery was more frequently performed in cases of giant adenomas and was associated with increased rates of ischemia and neurological deficits. Tumor recurrence was observed in 33% of patients over a mean follow-up of 48 months. Tumor size and postoperative complications such as hydrocephalus and ischemia were associated with increased morbidity and mortality.
CONCLUSION: Postoperative hydrocephalus, ischemia, and tumor size are key determinants of mortality in NFPA surgical treatment. Implementing preventive and management strategies targeting these complications could improve patient outcomes, albeit rigorous long-term follow-up is essential due to the high rates of recurrence and reoperation.
MATERIALS AND METHODS: We conducted a retrospective cohort study of patients with NFPA who underwent surgery between 1995 and 2024 at a tertiary public hospital in Brazil. Variables analyzed included tumor size, cavernous sinus invasion (Knosp classification), endocrinological status, preoperative clinical features, surgical complications, and outcomes. Statistical significance was set at p ≤ 0.05.
RESULTS: Seventy-three patients were included, with a mean age of 53 years and a slight predominance of females. Tumors were classified as macroadenomas (59%) and giant adenomas (41%). The transsphenoidal approach was used in 81% of cases. Partial resection was achieved in 56%, subtotal in 16%, and total in 27%. Immediate postoperative complications included diabetes insipidus (30%), bleeding (11%), hydrocephalus (10%), ischemia (10%), meningitis (6%), and cerebrospinal fluid fistula (11%). Mortality was 9.6%, significantly associated with postoperative hydrocephalus, ischemia, and larger tumor size. Giant tumors were correlated with higher rates of preoperative neurological deficits and postoperative complications. Transcranial surgery was more frequently performed in cases of giant adenomas and was associated with increased rates of ischemia and neurological deficits. Tumor recurrence was observed in 33% of patients over a mean follow-up of 48 months. Tumor size and postoperative complications such as hydrocephalus and ischemia were associated with increased morbidity and mortality.
CONCLUSION: Postoperative hydrocephalus, ischemia, and tumor size are key determinants of mortality in NFPA surgical treatment. Implementing preventive and management strategies targeting these complications could improve patient outcomes, albeit rigorous long-term follow-up is essential due to the high rates of recurrence and reoperation.