Frontiers in Neurology (Nov 2021)
Impact of Pituitary Stalk Preservation on Tumor Recurrence/Progression and Surgically Induced Endocrinopathy After Endoscopic Endonasal Resection of Suprasellar Craniopharyngiomas
- 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
Affiliations
- Zhengyuan Chen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Zhengyuan Chen
- Neurosurgical Institute of Fudan University, Shanghai, China
- Zhengyuan Chen
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Zhengyuan Chen
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Zhengyuan Chen
- Shanghai Pituitary Tumor Center, Shanghai, China
- Zhengyuan Chen
- National Center for Neurological Disorder, Shanghai, China
- Zengyi Ma
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Zengyi Ma
- Neurosurgical Institute of Fudan University, Shanghai, China
- Zengyi Ma
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Zengyi Ma
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Zengyi Ma
- Shanghai Pituitary Tumor Center, Shanghai, China
- Zengyi Ma
- National Center for Neurological Disorder, Shanghai, China
- Wenqiang He
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Wenqiang He
- Neurosurgical Institute of Fudan University, Shanghai, China
- Wenqiang He
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Wenqiang He
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Wenqiang He
- Shanghai Pituitary Tumor Center, Shanghai, China
- Wenqiang He
- National Center for Neurological Disorder, Shanghai, China
- Xuefei Shou
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Xuefei Shou
- Neurosurgical Institute of Fudan University, Shanghai, China
- Xuefei Shou
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Xuefei Shou
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Xuefei Shou
- Shanghai Pituitary Tumor Center, Shanghai, China
- Xuefei Shou
- National Center for Neurological Disorder, Shanghai, China
- Zhao Ye
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Zhao Ye
- Neurosurgical Institute of Fudan University, Shanghai, China
- Zhao Ye
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Zhao Ye
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Zhao Ye
- Shanghai Pituitary Tumor Center, Shanghai, China
- Zhao Ye
- National Center for Neurological Disorder, Shanghai, China
- Yichao Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Yichao Zhang
- Neurosurgical Institute of Fudan University, Shanghai, China
- Yichao Zhang
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Yichao Zhang
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Yichao Zhang
- Shanghai Pituitary Tumor Center, Shanghai, China
- Yichao Zhang
- National Center for Neurological Disorder, Shanghai, China
- Qilin Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Qilin Zhang
- Neurosurgical Institute of Fudan University, Shanghai, China
- Qilin Zhang
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Qilin Zhang
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Qilin Zhang
- Shanghai Pituitary Tumor Center, Shanghai, China
- Qilin Zhang
- National Center for Neurological Disorder, Shanghai, China
- Nidan Qiao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Nidan Qiao
- Neurosurgical Institute of Fudan University, Shanghai, China
- Nidan Qiao
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Nidan Qiao
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Nidan Qiao
- Shanghai Pituitary Tumor Center, Shanghai, China
- Nidan Qiao
- National Center for Neurological Disorder, Shanghai, China
- Xiang Zhou
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Xiang Zhou
- Neurosurgical Institute of Fudan University, Shanghai, China
- Xiang Zhou
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Xiang Zhou
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Xiang Zhou
- Shanghai Pituitary Tumor Center, Shanghai, China
- Xiang Zhou
- National Center for Neurological Disorder, Shanghai, China
- Xiaoyun Cao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Xiaoyun Cao
- Neurosurgical Institute of Fudan University, Shanghai, China
- Xiaoyun Cao
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Xiaoyun Cao
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Xiaoyun Cao
- Shanghai Pituitary Tumor Center, Shanghai, China
- Xiaoyun Cao
- National Center for Neurological Disorder, Shanghai, China
- Min He
- National Center for Neurological Disorder, Shanghai, China
- Min He
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Zhaoyun Zhang
- National Center for Neurological Disorder, Shanghai, China
- Zhaoyun Zhang
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Hongying Ye
- National Center for Neurological Disorder, Shanghai, China
- Hongying Ye
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Yiming Li
- National Center for Neurological Disorder, Shanghai, China
- Yiming Li
- Department of Endocrinology and Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shiqi Li
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Shiqi Li
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shiqi Li
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Shiqi Li
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Shiqi Li
- Shanghai Pituitary Tumor Center, Shanghai, China
- Shiqi Li
- National Center for Neurological Disorder, Shanghai, China
- Yao Zhao
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Yao Zhao
- Neurosurgical Institute of Fudan University, Shanghai, China
- Yao Zhao
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Yao Zhao
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Yao Zhao
- Shanghai Pituitary Tumor Center, Shanghai, China
- Yao Zhao
- National Center for Neurological Disorder, Shanghai, China
- Ming Shen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Ming Shen
- Neurosurgical Institute of Fudan University, Shanghai, China
- Ming Shen
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Ming Shen
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Ming Shen
- Shanghai Pituitary Tumor Center, Shanghai, China
- Ming Shen
- National Center for Neurological Disorder, Shanghai, China
- Yongfei Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Yongfei Wang
- Neurosurgical Institute of Fudan University, Shanghai, China
- Yongfei Wang
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
- Yongfei Wang
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Yongfei Wang
- Shanghai Pituitary Tumor Center, Shanghai, China
- Yongfei Wang
- National Center for Neurological Disorder, Shanghai, China
- Yongfei Wang
- Research Units of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences, Beijing, China
- DOI
- https://doi.org/10.3389/fneur.2021.753944
- Journal volume & issue
-
Vol. 12
Abstract
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.
Keywords
