Impact of Pituitary Stalk Preservation on Tumor Recurrence/Progression and Surgically Induced Endocrinopathy After Endoscopic Endonasal Resection of Suprasellar Craniopharyngiomas

Objective: To investigate the factors associated with recurrence/progression after endoscopic endonasal resection of suprasellar craniopharyngiomas. Special attention was paid to assess the impact of pituitary stalk preservation on tumor recurrence/progression and endocrinological outcomes.Methods:...

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Autores principales:	Zhengyuan Chen, Zengyi Ma, Wenqiang He, Xuefei Shou, Zhao Ye, Yichao Zhang, Qilin Zhang, Nidan Qiao, Xiang Zhou, Xiaoyun Cao, Min He, Zhaoyun Zhang, Hongying Ye, Yiming Li, Shiqi Li, Yao Zhao, Ming Shen, Yongfei Wang
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	craniopharyngioma EEA surgery pituitary stalk recurrence progression endocrinopathy Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/5e34dd74eb814b089d4c82277bd5718f
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id	oai:doaj.org-article:5e34dd74eb814b089d4c82277bd5718f
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	craniopharyngioma EEA surgery pituitary stalk recurrence progression endocrinopathy Neurology. Diseases of the nervous system RC346-429
spellingShingle	craniopharyngioma EEA surgery pituitary stalk recurrence progression endocrinopathy Neurology. Diseases of the nervous system RC346-429 Zhengyuan Chen Zhengyuan Chen Zhengyuan Chen Zhengyuan Chen Zhengyuan Chen Zhengyuan Chen Zengyi Ma Zengyi Ma Zengyi Ma Zengyi Ma Zengyi Ma Zengyi Ma Wenqiang He Wenqiang He Wenqiang He Wenqiang He Wenqiang He Wenqiang He Xuefei Shou Xuefei Shou Xuefei Shou Xuefei Shou Xuefei Shou Xuefei Shou Zhao Ye Zhao Ye Zhao Ye Zhao Ye Zhao Ye Zhao Ye Yichao Zhang Yichao Zhang Yichao Zhang Yichao Zhang Yichao Zhang Yichao Zhang Qilin Zhang Qilin Zhang Qilin Zhang Qilin Zhang Qilin Zhang Qilin Zhang Nidan Qiao Nidan Qiao Nidan Qiao Nidan Qiao Nidan Qiao Nidan Qiao Xiang Zhou Xiang Zhou Xiang Zhou Xiang Zhou Xiang Zhou Xiang Zhou Xiaoyun Cao Xiaoyun Cao Xiaoyun Cao Xiaoyun Cao Xiaoyun Cao Xiaoyun Cao Min He Min He Zhaoyun Zhang Zhaoyun Zhang Hongying Ye Hongying Ye Yiming Li Yiming Li Shiqi Li Shiqi Li Shiqi Li Shiqi Li Shiqi Li Shiqi Li Yao Zhao Yao Zhao Yao Zhao Yao Zhao Yao Zhao Yao Zhao Ming Shen Ming Shen Ming Shen Ming Shen Ming Shen Ming Shen Yongfei Wang Yongfei Wang Yongfei Wang Yongfei Wang Yongfei Wang Yongfei Wang Yongfei Wang Impact of Pituitary Stalk Preservation on Tumor Recurrence/Progression and Surgically Induced Endocrinopathy After Endoscopic Endonasal Resection of Suprasellar Craniopharyngiomas
description	Objective: To investigate the factors associated with recurrence/progression after endoscopic endonasal resection of suprasellar craniopharyngiomas. Special attention was paid to assess the impact of pituitary stalk preservation on tumor recurrence/progression and endocrinological outcomes.Methods: We retrospectively recruited 73 patients with suprasellar craniopharyngiomas undergone endoscopic endonasal approach (EEA) surgery from September 2014 to May 2019 and assessed their clinical characteristics, surgical outcomes, and recurrence/progression. Stalk preservation or sacrifice was determined by reviewing operative records, videos, and post-operative magnetic resonance imaging.Results: Gross total resection (GTR) was achieved in 51 cases (69.9%). Tumor recurrence was seen in 5 cases (9.8%) and progression was seen in 8 cases (36.4%), respectively. GTR (OR = 0.248 CI 0.081–0.759; p = 0.015) was the only independent factor influencing recurrence/progression. Kaplan-Meier survival analysis showed that the mean recurrence/progression-free survival were 53 (95% CI 48–59) and 39 (95% CI 28–50) months, respectively, in patients with and without GTR (p = 0.011). Pituitary stalk preservation was more common in cases with peripheral type tumors (83% vs. 30%, p < 0.01). Preserving the pituitary stalk does not appear to decrease the percentage of GTR (75.5% vs. 55.0%, p = 0.089), or increase the rate of tumor recurrence (12.5% vs. 0%, p = 0.508) or progression (46.2% vs. 22.2%, p = 0.486). However, surgically induced hypothyroidism (60.5% vs. 100%, p = 0.041) and diabetes insipidus (35.1% vs. 81.8%, p = 0.017) were significantly lower in patients with stalk preservation. For patients who had hypopituitarism before EEA, there was no difference between those with and without stalk preservation regarding post-operative hypopituitarism (p > 0.05).Conclusion: GTR is the only independent predictor of recurrence/progression after EEA surgery for suprasellar craniopharyngiomas. Preserving the pituitary stalk does not appear to increase the risk of non-GTR and tumor recurrence/progression and might help reduce the risk of surgically induced hypothyroidism and diabetes insipidus. We recommend preserving the pituitary stalk in peripheral type suprasellar craniopharyngiomas with normal pituitary function, especially in cases without hypothyroidism or diabetes insipidus. On the other hand, stalk sacrifice could be considered in central type tumors with severe pre-operative endocrinopathy.
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author	Zhengyuan Chen Zhengyuan Chen Zhengyuan Chen Zhengyuan Chen Zhengyuan Chen Zhengyuan Chen Zengyi Ma Zengyi Ma Zengyi Ma Zengyi Ma Zengyi Ma Zengyi Ma Wenqiang He Wenqiang He Wenqiang He Wenqiang He Wenqiang He Wenqiang He Xuefei Shou Xuefei Shou Xuefei Shou Xuefei Shou Xuefei Shou Xuefei Shou Zhao Ye Zhao Ye Zhao Ye Zhao Ye Zhao Ye Zhao Ye Yichao Zhang Yichao Zhang Yichao Zhang Yichao Zhang Yichao Zhang Yichao Zhang Qilin Zhang Qilin Zhang Qilin Zhang Qilin Zhang Qilin Zhang Qilin Zhang Nidan Qiao Nidan Qiao Nidan Qiao Nidan Qiao Nidan Qiao Nidan Qiao Xiang Zhou Xiang Zhou Xiang Zhou Xiang Zhou Xiang Zhou Xiang Zhou Xiaoyun Cao Xiaoyun Cao Xiaoyun Cao Xiaoyun Cao Xiaoyun Cao Xiaoyun Cao Min He Min He Zhaoyun Zhang Zhaoyun Zhang Hongying Ye Hongying Ye Yiming Li Yiming Li Shiqi Li Shiqi Li Shiqi Li Shiqi Li Shiqi Li Shiqi Li Yao Zhao Yao Zhao Yao Zhao Yao Zhao Yao Zhao Yao Zhao Ming Shen Ming Shen Ming Shen Ming Shen Ming Shen Ming Shen Yongfei Wang Yongfei Wang Yongfei Wang Yongfei Wang Yongfei Wang Yongfei Wang Yongfei Wang
author_facet	Zhengyuan Chen Zhengyuan Chen Zhengyuan Chen Zhengyuan Chen Zhengyuan Chen Zhengyuan Chen Zengyi Ma Zengyi Ma Zengyi Ma Zengyi Ma Zengyi Ma Zengyi Ma Wenqiang He Wenqiang He Wenqiang He Wenqiang He Wenqiang He Wenqiang He Xuefei Shou Xuefei Shou Xuefei Shou Xuefei Shou Xuefei Shou Xuefei Shou Zhao Ye Zhao Ye Zhao Ye Zhao Ye Zhao Ye Zhao Ye Yichao Zhang Yichao Zhang Yichao Zhang Yichao Zhang Yichao Zhang Yichao Zhang Qilin Zhang Qilin Zhang Qilin Zhang Qilin Zhang Qilin Zhang Qilin Zhang Nidan Qiao Nidan Qiao Nidan Qiao Nidan Qiao Nidan Qiao Nidan Qiao Xiang Zhou Xiang Zhou Xiang Zhou Xiang Zhou Xiang Zhou Xiang Zhou Xiaoyun Cao Xiaoyun Cao Xiaoyun Cao Xiaoyun Cao Xiaoyun Cao Xiaoyun Cao Min He Min He Zhaoyun Zhang Zhaoyun Zhang Hongying Ye Hongying Ye Yiming Li Yiming Li Shiqi Li Shiqi Li Shiqi Li Shiqi Li Shiqi Li Shiqi Li Yao Zhao Yao Zhao Yao Zhao Yao Zhao Yao Zhao Yao Zhao Ming Shen Ming Shen Ming Shen Ming Shen Ming Shen Ming Shen Yongfei Wang Yongfei Wang Yongfei Wang Yongfei Wang Yongfei Wang Yongfei Wang Yongfei Wang
author_sort	Zhengyuan Chen
title	Impact of Pituitary Stalk Preservation on Tumor Recurrence/Progression and Surgically Induced Endocrinopathy After Endoscopic Endonasal Resection of Suprasellar Craniopharyngiomas
title_short	Impact of Pituitary Stalk Preservation on Tumor Recurrence/Progression and Surgically Induced Endocrinopathy After Endoscopic Endonasal Resection of Suprasellar Craniopharyngiomas
title_full	Impact of Pituitary Stalk Preservation on Tumor Recurrence/Progression and Surgically Induced Endocrinopathy After Endoscopic Endonasal Resection of Suprasellar Craniopharyngiomas
title_fullStr	Impact of Pituitary Stalk Preservation on Tumor Recurrence/Progression and Surgically Induced Endocrinopathy After Endoscopic Endonasal Resection of Suprasellar Craniopharyngiomas
title_full_unstemmed	Impact of Pituitary Stalk Preservation on Tumor Recurrence/Progression and Surgically Induced Endocrinopathy After Endoscopic Endonasal Resection of Suprasellar Craniopharyngiomas
title_sort	impact of pituitary stalk preservation on tumor recurrence/progression and surgically induced endocrinopathy after endoscopic endonasal resection of suprasellar craniopharyngiomas
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/5e34dd74eb814b089d4c82277bd5718f
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spelling	oai:doaj.org-article:5e34dd74eb814b089d4c82277bd5718f2021-11-04T04:43:42ZImpact of Pituitary Stalk Preservation on Tumor Recurrence/Progression and Surgically Induced Endocrinopathy After Endoscopic Endonasal Resection of Suprasellar Craniopharyngiomas1664-229510.3389/fneur.2021.753944https://doaj.org/article/5e34dd74eb814b089d4c82277bd5718f2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.753944/fullhttps://doaj.org/toc/1664-2295Objective: To investigate the factors associated with recurrence/progression after endoscopic endonasal resection of suprasellar craniopharyngiomas. Special attention was paid to assess the impact of pituitary stalk preservation on tumor recurrence/progression and endocrinological outcomes.Methods: We retrospectively recruited 73 patients with suprasellar craniopharyngiomas undergone endoscopic endonasal approach (EEA) surgery from September 2014 to May 2019 and assessed their clinical characteristics, surgical outcomes, and recurrence/progression. Stalk preservation or sacrifice was determined by reviewing operative records, videos, and post-operative magnetic resonance imaging.Results: Gross total resection (GTR) was achieved in 51 cases (69.9%). Tumor recurrence was seen in 5 cases (9.8%) and progression was seen in 8 cases (36.4%), respectively. GTR (OR = 0.248 CI 0.081–0.759; p = 0.015) was the only independent factor influencing recurrence/progression. Kaplan-Meier survival analysis showed that the mean recurrence/progression-free survival were 53 (95% CI 48–59) and 39 (95% CI 28–50) months, respectively, in patients with and without GTR (p = 0.011). Pituitary stalk preservation was more common in cases with peripheral type tumors (83% vs. 30%, p < 0.01). Preserving the pituitary stalk does not appear to decrease the percentage of GTR (75.5% vs. 55.0%, p = 0.089), or increase the rate of tumor recurrence (12.5% vs. 0%, p = 0.508) or progression (46.2% vs. 22.2%, p = 0.486). However, surgically induced hypothyroidism (60.5% vs. 100%, p = 0.041) and diabetes insipidus (35.1% vs. 81.8%, p = 0.017) were significantly lower in patients with stalk preservation. For patients who had hypopituitarism before EEA, there was no difference between those with and without stalk preservation regarding post-operative hypopituitarism (p > 0.05).Conclusion: GTR is the only independent predictor of recurrence/progression after EEA surgery for suprasellar craniopharyngiomas. Preserving the pituitary stalk does not appear to increase the risk of non-GTR and tumor recurrence/progression and might help reduce the risk of surgically induced hypothyroidism and diabetes insipidus. We recommend preserving the pituitary stalk in peripheral type suprasellar craniopharyngiomas with normal pituitary function, especially in cases without hypothyroidism or diabetes insipidus. On the other hand, stalk sacrifice could be considered in central type tumors with severe pre-operative endocrinopathy.Zhengyuan ChenZhengyuan ChenZhengyuan ChenZhengyuan ChenZhengyuan ChenZhengyuan ChenZengyi MaZengyi MaZengyi MaZengyi MaZengyi MaZengyi MaWenqiang HeWenqiang HeWenqiang HeWenqiang HeWenqiang HeWenqiang HeXuefei ShouXuefei ShouXuefei ShouXuefei ShouXuefei ShouXuefei ShouZhao YeZhao YeZhao YeZhao YeZhao YeZhao YeYichao ZhangYichao ZhangYichao ZhangYichao ZhangYichao ZhangYichao ZhangQilin ZhangQilin ZhangQilin ZhangQilin ZhangQilin ZhangQilin ZhangNidan QiaoNidan QiaoNidan QiaoNidan QiaoNidan QiaoNidan QiaoXiang ZhouXiang ZhouXiang ZhouXiang ZhouXiang ZhouXiang ZhouXiaoyun CaoXiaoyun CaoXiaoyun CaoXiaoyun CaoXiaoyun CaoXiaoyun CaoMin HeMin HeZhaoyun ZhangZhaoyun ZhangHongying YeHongying YeYiming LiYiming LiShiqi LiShiqi LiShiqi LiShiqi LiShiqi LiShiqi LiYao ZhaoYao ZhaoYao ZhaoYao ZhaoYao ZhaoYao ZhaoMing ShenMing ShenMing ShenMing ShenMing ShenMing ShenYongfei WangYongfei WangYongfei WangYongfei WangYongfei WangYongfei WangYongfei WangFrontiers Media S.A.articlecraniopharyngiomaEEA surgerypituitary stalkrecurrenceprogressionendocrinopathyNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)

Impact of Pituitary Stalk Preservation on Tumor Recurrence/Progression and Surgically Induced Endocrinopathy After Endoscopic Endonasal Resection of Suprasellar Craniopharyngiomas

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