Operative Nuances of Capsular Dissection Techniques and Capsule Morphology in Pituitary Adenomas: Past 1-Year Case Experiences of a Tertiary Center

Eren Yilmaz; Ayse Uzuner; Ecem Cemre Ceylan; Pinar Yildirim; Seda Duman Ozturk; Atakan Emengen; Aykut Gokbel; Melih Caklili; Burak Cabuk; Ihsan Anik; Savas Ceylan

doi:10.1227/ons.0000000000001183

Operative Nuances of Capsular Dissection Techniques and Capsule Morphology in Pituitary Adenomas: Past 1-Year Case Experiences of a Tertiary Center

Oper Neurosurg (Hagerstown). 2024 May 8. doi: 10.1227/ons.0000000000001183. Online ahead of print.

Authors

Affiliations

¹ Department of Neurosurgery, Cihanbeyli State Hospital, Konya, Turkey.
² Department of Neurosurgery, Pituitary Research Center, Kocaeli University School of Medicine, Kocaeli, Turkey.
³ Department of Pathology, Kocaeli University School of Medicine, Kocaeli, Turkey.
⁴ Department of Neurosurgery, Bahcesehir University School of Medicine, Istanbul, Turkey.
⁵ Current affiliation: Department of Neurosurgery, Bahcesehir University School of Medicine, Istanbul, Turkey.

PMID: 38717165
DOI: 10.1227/ons.0000000000001183

Abstract

Background and objectives: The widespread use of endoscope and increased surgical experiences in pituitary adenomas (PAs) has raised the expectations for higher resection and cure rates. The subject that will meet this expectation in all types of adenomas is the capsule and its dissection. The purpose of this study was to go beyond the commonly mentioned pseudocapsule definition for small-sized adenomas in previous studies and to describe the capsule structure in different morphologies present in pituitary adenomas of all sizes. This includes detailing the nuances of capsular dissection (CD) and presenting postoperative surgical outcomes through the experiences of a high-volume tertiary center.

Methods: In our center, 534 patients underwent endoscopic trans-sphenoidal surgery because of pituitary adenoma in 2022 by the same surgeon. The data of the patients were examined retrospectively. The surgical techniques applied were grouped as adenoma resection only, capsular resection after internal debulking, and direct extracapsular resection.

Results: CD was performed in 275 (51.5%) patients. The gross total resection (GTR) rate in nonsecretory adenomas with and without CD was 90.7% (97/107) and 90.7% (97/107), respectively. The remission rate in secretory adenomas with and without CD was 81.0% (136/168) and 44.0% (67/152), respectively. When the patients were examined in 2 groups as those who underwent CD and those who did not, the application of CD had a positive predictive value in terms of GTR/remission (P: .036). Capsule thickness was not found to be statistically significant depending on tumor subtype, size, and aggressiveness, but capsule thickness was statistically significant in terms of total capsular resection (P: .045).

Conclusion: The morphology of the capsule, tumor size/subtype/consistency, and patient-specific factors are crucial for the selection of the surgical technique to be applied. It is possible to increase the GTR/remission rates in adenomas of all sizes by capsule dissection. Moreover, performing CD does not contribute significantly to the development of potential complications in such cases.