Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Surgical Techniques and Technologies for the Management of Patients With Nonfunctioning Pituitary Adenomas.
Publication/Presentation Date
10-1-2016
Abstract
BACKGROUND: Numerous technological adjuncts are used during transsphenoidal surgery for nonfunctioning pituitary adenomas (NFPAs), including endoscopy, neuronavigation, intraoperative magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) diversion, and dural closure techniques.
OBJECTIVE: To generate evidence-based guidelines for the use of NFPA surgical techniques and technologies.
METHODS: An extensive literature search spanning January 1, 1966, to October 1, 2014, was performed, and only articles pertaining to technological adjuncts for NFPA resection were included. The clinical assessment evidence-based classification was used to ascertain the class of evidence.
RESULTS: Fifty-six studies met the inclusion criteria, and evidence-based guidelines were formulated on the use of endoscopy, neuronavigation, intraoperative MRI, CSF diversion, and dural closure techniques.
CONCLUSION: Both endoscopic and microscopic transsphenoidal approaches are recommended for symptom relief in patients with NFPAs, with the extent of tumor resection improved by adequate bony exposure and endoscopic visualization. In select cases, combined transcranial and transsphenoidal approaches are recommended. Although intraoperative MRI can improve gross total resection, its use is associated with an increased false-positive rate and is thus not recommended. There is insufficient evidence to recommend the use of neuronavigation, CSF diversion, intrathecal injection, or specific dural closure techniques. The full guidelines document for this chapter can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas/Chapter_6.
ABBREVIATIONS: CSF, cerebrospinal fluidNFPA, nonfunctioning pituitary adenoma.
Volume
79
Issue
4
First Page
536
Last Page
538
ISSN
1524-4040
Published In/Presented At
Kuo, J. S., Barkhoudarian, G., Farrell, C. J., Bodach, M. E., Tumialan, L. M., Oyesiku, N. M., Litvack, Z., Zada, G., Patil, C. G., & Aghi, M. K. (2016). Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Surgical Techniques and Technologies for the Management of Patients With Nonfunctioning Pituitary Adenomas. Neurosurgery, 79(4), E536–E538. https://doi.org/10.1227/NEU.0000000000001390
Disciplines
Medicine and Health Sciences
PubMedID
27635962
Department(s)
Department of Surgery
Document Type
Article