Endoscopic endonasal surgery for non-invasive pituitary neuroendocrinology tumors with incomplete pseudocapsule

Gang Zhang; Pan Wang; Junwei Wang; Dewei Zou; Hui Yao; Jie Liu; Chao Tang; Haotian Jiang; Xiaorong Tan; Nan Wu

doi:10.3389/fneur.2023.1109388

Endoscopic endonasal surgery for non-invasive pituitary neuroendocrinology tumors with incomplete pseudocapsule

Front Neurol. 2023 Mar 27:14:1109388. doi: 10.3389/fneur.2023.1109388. eCollection 2023.

Authors

Gang Zhang^{1

2}, Pan Wang^{1

2}, Junwei Wang¹, Dewei Zou¹, Hui Yao³, Jie Liu^{1

2}, Chao Tang^{1

2}, Haotian Jiang^{1

2}, Xiaorong Tan^{1

2}, Nan Wu¹

Affiliations

¹ Department of Neurosurgery, Chongqing General Hospital, Chongqing, China.
² Chongqing Medical University, Chongqing, China.
³ Department of Pathology, Chongqing General Hospital, Chongqing, China.

Abstract

Background: Pituitary neuroendocrinology tumors (PitNETs) with pseudocapsule can be effectively removed by the pseudocapsule-based extracapsular resection technique. In the areas without pseudocapsule, the tumor cells can spread into the adjacent tissues at the cellular level, which brings a great challenge to achieving total tumor resection.

Methods: Our surgical strategy for PitNETs with an incomplete pseudocapsule is to combine the pseudocapsule-based extracapsular resection technique with the intensive excision technique for the removal of the tumor. Specifically, the pseudocapsule-based extracapsular resection technique is applied in the areas with pseudocapsule, while in the areas without pseudocapsule, the intensive excision technique bounded by adjacent normal structures is adopted. Moreover, a pathological examination was performed to determine the situations of pseudocapsule and tumor cell remnant.

Results: All growth hormone-secreting PitNETs achieved biochemical remission after surgery. There was no deterioration of pituitary functions postoperatively, and the preoperative hypopituitarism had improved in all patients postoperatively. In total, two cases suffered a transient diabetes insipidus, and intraoperative cerebrospinal fluid leakage was observed in two cases but no postoperative cerebrospinal fluid leakage in all cases. There was no recurrence during the follow-up. The fragmental pseudocapsule and small tumor remnants were found in the majority of suspicious tissues by histological staining.

Conclusion: The effectiveness and safety of the surgical strategy were preliminarily explored for removing PitNETs without incomplete pseudocapsules. In overview, the pseudocapsule-based extracapsular resection technique is applied in areas with pseudocapsule, while the intensive excision bounded by adjacent normal structures is adopted in other areas.

Keywords: endoscopic endonasal surgery; intensive excision; pituitary neuroendocrinology tumors; pseudocapsule; pseudocapsule-based extracapsular resection.