Radiological Knosp, Revised-Knosp, and Hardy-Wilson Classifications for the Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary Adenomas: Study of 228 Cases

Marta Araujo-Castro; Alberto Acitores Cancela; Carlos Vior; Eider Pascual-Corrales; Víctor Rodríguez Berrocal

doi:10.3389/fonc.2021.807040

Radiological Knosp, Revised-Knosp, and Hardy-Wilson Classifications for the Prediction of Surgical Outcomes in the Endoscopic Endonasal Surgery of Pituitary Adenomas: Study of 228 Cases

Front Oncol. 2022 Jan 20:11:807040. doi: 10.3389/fonc.2021.807040. eCollection 2021.

Authors

Marta Araujo-Castro^{1

2}, Alberto Acitores Cancela³, Carlos Vior³, Eider Pascual-Corrales¹, Víctor Rodríguez Berrocal^{3

4}

Affiliations

¹ Neuroendocrinology Unit, Department of Endocrinology & Nutrition, Hospital Universitario Ramón y Cajal & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain.
² Department of Medicine, Universidad de Alcalá de Henares, Madrid, Spain.
³ Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain.
⁴ Department of Neurosurgery, Hospital HM Puerta del Sur, Madrid, Spain.

Abstract

Purpose: To evaluate which radiological classification, Knosp, revised-Knosp, or Hardy-Wilson classification, is better for the prediction of surgical outcomes in the endoscopic endonasal transsphenoidal (EET) surgery of pituitary adenomas (PAs).

Methods: This is a retrospective study of patients with PAs who underwent EET PA resection for the first time between January 2009 and December 2020. Radiological cavernous sinus invasiveness was defined as a Knosp or revised-Knosp grade >2 or a grade E in the Hardy-Wilson classification.

Results: A total of 228 patients with PAs were included. Cavernous sinus invasion was evident in 35.1% and suprasellar extension was evident in 74.6%. Overall, surgical cure was achieved in 64.3% of patients. Surgical cure was lower in invasive PAs than in non-invasive PAs (28.8% vs. 83.1%, p < 0.0001), and the risk of major complications was higher (13.8% vs. 3.4%, p = 0.003). The rate of surgical cure decreased as the grade of Knosp increased (p < 0.001), whereas the risk of complications increased (p < 0.001). Patients with Knosp 3B PAs tended to achieve surgical cure less commonly than Knosp 3A PAs (30.0% vs. 56.0%, p = 0.164). Similar results were observed based on the invasion and extension of Hardy-Wilson classification (stage A-C 83.1% vs. E 28.8% p < 0.0001, grade 0-II 81.1% vs. III-IV 59.7% p = 0.008). The Knosp classification offered the greatest diagnostic accuracy for the prediction of surgical cure (AUC 0.820), whereas the invasion Hardy-Wilson classification lacked utility for this purpose (AUC 0.654).

Conclusion: The Knosp classifications offer a good orientation for the estimation of surgical cure and the risk of complications in patients with PAs submitted to EET surgery. However, the invasion Hardy-Wilson scale lacks utility for this purpose.

Keywords: Hardy-Wilson classification; Knosp classification; endoscopic endonasal transsphenoidal surgery; invasive pituitary adenomas; pituitary adenomas.