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현재 페이지 위치 : 뇌하수체종양클리닉 > 자료실 > 학술활동

학술활동

글 내용
제목 2016년도 학술활동
작성자 관리자 등록일 2017-11-10

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2016 Apr;4(1):1-7. doi: 10.14791/btrt.2016.4.1.1. Epub 2016 Apr 29.

Clinical Concerns about Recurrence of Non-Functioning Pituitary Adenoma.

Lee MH1, Lee JH1, Seol HJ1, Lee JI1, Kim JH2, Kong DS1, Nam DH1.

Abstract

BACKGROUND:

Non-functioning pituitary adenomas (NFPA) are clinically challenging because they present at a late stage with local mass effects or hypopituitarism. Surgery for non-functioning pituitary adenoma requires a special strategic approach for both minimal morbidity and radical resection. However, the clinical predictive factors associated with recurrence are limited. Here, we investigated optimal treatment of non-functioning pituitary adenoma.

METHODS:

We enrolled 289 patients who presented with non-functioning pituitary adenoma between January 2000 and January 2012 and who had received follow-up for at least one year for this retrospective study. Of these patients, 152 were male and 137 were female, with a median age of 51 years (range 15.79 years) and a median follow-up of four years (range 1.12.6 years). Characteristics of patients and tumors were reviewed with electronic medical records and radiologic images, retrospectively.

RESULTS:

Of the tumors, 193 were gross-totally resected, 53 were near-totally resected, and 43 were sub-totally resected. The extent of resection and adjuvant radiotherapy were both statistically significant prognostic factors of recurrence. Immunohistochemistry of tumor specimens did not yield consistent results.

CONCLUSION:

With a high rate of recurrence, NFPA should be closely followed-up over a long-term period. Improvement of surgical techniques with advanced surgical equipment and adjuvant radiosurgery would lead to reduce the recurrence rate and improve patients' outcome.

KEYWORDS:

Nonfunctioning; Pituitary adenoma; Radiosurgery; Radiotherapy; Recurrence

 

 

2016 Jun;90:496-503. doi: 10.1016/j.wneu.2016.03.050. Epub 2016 Mar 26.

Serial Re-Expansion of Pituitary Gland Is Associated with Endocrinologic Recovery.

Cho KR1, Hong SD2, Hur KY3, Kim ST4, Seol HJ1, Lee JI1, Kong DS5, Nam DH6.

Abstract

BACKGROUND:

Minimizing pituitary dysfunction by preservation of the normal pituitary gland has a significant clinical impact on patient outcome after pituitary surgery. This study aimed to determine whether re-expansion of the healthy gland after surgery was related to endocrinologic outcome.

METHODS:

From January 2012 to July 2014, 112 patients were eligible for this retrospective study. Magnetic resonance imaging with dynamic contrast enhancement done2 days and 3 months before and after surgery was evaluated to assess the tumor and normal pituitary gland. We assessed the size of the pituitary gland and evaluated the relationship with endocrinologic outcome.

RESULTS:

The mean preoperative size of the gland was 3.86 mm, within 2 days after surgery it was 5.50 mm and 3 months after surgery it was 7.17 mm. Preoperatively patients were grouped based on their requirement of hormone replacement. Patients who required hormone replacement therapy before surgery and did not recover from hormonal insufficiency were classified as group 1 (26 patients), those who recovered from preoperative hormonal insufficiency and discontinued hormone replacement after surgery were classified as group 2 (17 patients), and those who showed hormonally normal status and did not need hormone replacement before and after surgery were in group 3 (68 patients). In group 1, the size of the gland expanded 1.24 times within postoperative 2 days but had no increase after 3 months (1.25 mm) (P = 0.716). Group 2 showed a 1.30 times larger gland within postoperative 2 days and 2.37 times at 3 months follow-up (P = 0.001). Group 3 showed 1.62 times larger gland at postoperative day 2 and 2.1 times larger at the 3-month follow-up.

CONCLUSIONS:

Serial re-expansion of the healthy pituitary gland at the 3-month follow-up magnetic resonance imaging can predict the endocrinologic recovery.

Copyright © 2016 Elsevier Inc. All rights reserved.

KEYWORDS:

Endoscopic surgery; Hormone replacement therapy; Pituitary adenoma; Pituitary gland; Trans-sphenoidal approach

 

 

2016 Sep;93:164-7. doi: 10.1016/j.wneu.2016.06.006. Epub 2016 Jun 11.

Nasoseptal Flap Elevation in Patients with History of Septal Surgery: Does It Increase Flap Failure or Cerebrospinal Fluid Leakage?

Park W1, Hong SD2, Nam DH3, Kong DS3, Ryu G1, Kim HY1, Chung SK1, Dhong HJ1.

Abstract

OBJECTIVE:

The nasoseptal flap (NSF) has been shown to be a mainstay in the reconstruction of skull base defects. We evaluated the efficacy and complications of NSF in patients with a history of septal surgery who had the potential risk of tearing and poor vascularity.

METHODS:

We performed a retrospective chart and video review of patients who underwent NSF for skull base reconstruction between February 2012 and May 2015. Comparison was made between 18 patients (revision group) who had a history of septoplasty and/or transseptal transsphenoidal approach and 88 patients (primary group) without a history of septal surgery. Laceration when raising the flap, vascularity on postoperative magnetic resonance imaging, viability on postoperative endoscopy, and cerebrospinal fluid (CSF) leakage were compared between the revision and primary groups.

RESULTS:

Laceration of the flap occurred during NSF elevation in 2 patients (11.1%) in the revision group and 4 patients (4.5%) in the primary group (P = 0.269). Poor flap vascularity on magnetic resonance imaging was observed in 2 patients (11.1%) in the revision group and 8 patients (9.1%) in the primary group (P = 0.674). The rate of flap necrosis on endoscopy was 5.6% in the revision group and 1.1% in the primary group (P = 0.312). There was no significant difference in CSF leakage rate between the 2 groups (revision 5.6% and primary 10.2%).

CONCLUSIONS:

There was no difference in rate of CSF leakage or flap integrity between the 2 groups. Therefore, NSF for skull base reconstruction is feasible in patients with a history of septal surgery.

Copyright © 2016 Elsevier Inc. All rights reserved.

KEYWORDS:

Cerebrospinal fluid leakage; Nasoseptal flap; Septal surgery; Skull base reconstruction

 

 

2016 Oct;4(2):63-69. Epub 2016 Oct 31.

Therapeutic Strategy for Cavernous Sinus-Invading Non-Functioning Pituitary Adenomas Based on the Modified Knosp Grading System.

Hwang J1, Seol HJ1, Nam DH1, Lee JI1, Lee MH1, Kong DS1.

Abstract

BACKGROUND:

Non-functioning pituitary adenomas (NFPA) invading into the cavernous sinus are surgically challenging. To decrease recurrence rate, surgeon makes a strong endeavor to resect tumor gross totally. However, gross total resection (GTR) is difficult to achieve with cavernous sinus invasion. Recently, a new classification system for cavernous invasion of pituitary adenomas was suggested. The aim of this study is to validate this new classification system and to identify limitations and considerations in designing treatment strategies for patients with NFPA involving the cavernous sinus.

METHODS:

Between January 2000 and January 2012, 275 patients who underwent operation for NFPA were enrolled in the study. Median age was 50 years (15-79 years). There were 145 males and 130 females. The median follow-up duration was 4 years (range 1-12.5 years).

RESULTS:

Related to extent of tumor removal, GTR was obtained in 184 patients (66.9%), near total resection (NTR) was obtained in 45 patients (16.3%), and sub-total resection (STR) was obtained in 46 patients (16.7%) of a total 275 patients. There were statistically significant differences between the extent of resection and the new Knosp classification (p<0.001). In the high-grade group of the new Knosp classification, there was no difference in recurrence between patients who underwent GTR or NTR only and those who underwent STR with adjuvant radiation therapy (p=0.515).

CONCLUSION:

In case of high risk of surgical complications, STR with adjuvant radiation therapy can be considered as an alternative strategy for safe treatment of cavernous-invading adenomas.

KEYWORDS:

Cavernous sinus; Pituitary adenoma; Radiation therapy; Recurrence

 

 

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