Jacqueline Lattmann, Javier Fandino, Sven Berkmann
Shape of pituitary adenoma as a predictor for clinical and radiological outcome (ShAPe Trial)
(1) Department of Neurosurgery, Kantonsspital Aarau, Aarau/Switzerland
The goals of surgery for pituitary lesions are cure of endocrinological syndromes (e.g. acromegaly), neurological deficits (e.g. optic chiasm compression syndrome), restoration of pituitary function and long-term (tumor) control. With the evolution of the transsphenoidal approach, several tools like the X-ray intensifier, cisternography, sonography, computed tomography, the endoscope, and the intraoperative MRI (iMRI) have been used to increase visualization of the tumor and thereby to make surgery safer and increase the extent of resection.
The two significant advances in pituitary surgery during the past 15 years have been the tailoring of the endonasal endoscopic approach and the implementation of intraoperative magnetic resonance imaging. Each provides improved visualization of intra- and parasellar anatomy with the goal of attaining a complete resection. Nevertheless, even in experienced hands, tumor remnants – visualized or not – may be left behind. Factors, which may predispose for incomplete resection are invasiveness and awkward tumor shapes. While different classifications for grading the invasive growth have been proposed in the literature, a similar tool is lacking for tumor shapes. Until now, there is no common way for investigators to distinguish different tumor shapes and the influence on resection rates has not been thoroughly assessed.A classification for different tumor shapes was suggested by the investigators. The aim of this retrospective single center outcome study is to evaluate the influence of the tumor-shape on the clinical and radiological outcome in >200 patients undergoing transsphenoidal surgery.
AIM. The primary objective of this study is to evaluate the influence of different tumor-shapes of pituitary adenomas on the operability and the outcome in patients operated from 2006 until 2016. This may result in a comparably large number of patients (n>200) and a comparably long follow-up time (>5 years).