Top

Acta Neurochirurgica

Published in:

01-09-2013 | Clinical Article - Brain Tumors

Endoscopic distinction between capsule and pseudocapsule of pituitary adenomas

Authors: Savas Ceylan, Burak Cabuk, Kenan Koc, Ihsan Anik, Cigdem Vural

Published in: Acta Neurochirurgica | Issue 9/2013

Abstract

Background

Pseudocapsules were first identified in pituitary adenoma surgery in 1936. Since then, the distinction between pituitary capsules and pseudocapsules has been unclear, and the definitions of these entities have varied. In this study, pituitary capsules and extracapsular dissection were examined retrospectively, intra- and extrapseudocapsular resection was evaluated, and dissection of the pituitary adenoma and pseudocapsule was examined prospectively.

Methods

Between January 2009 and May 2012, endoscopic transsphenoidal pituitary surgery was performed on 224 patients in the Department of Neurosurgery, Kocaeli University Faculty of Medicine, Turkey. Data for 174 patients were analyzed retrospectively between January 2009 and December 2011, and 50 patients treated between December 2011 and May 2012 were included in a prospective study.

Results

In the retrospective phase of the study, capsules were examined in 21 of the 174 patients on whom extracapsular resection had been performed. In the 50 cases treated between December 2011 and May 2012, dissection of the pituitary capsule, adenohypophysis, and pseudocapsule was performed. In 30 patients in the prospective phase of the study, pseudocapsules were identified during intraoperative endoscopic observation. Remission was achieved in 28 of 33 functioning adenomas in the prospective study. The mean follow-up period in this group was 13 months.

Conclusion

The endoscopic and histopathological evidence provided in this study demonstrates that the pituitary capsule and pseudocapsule are distinct structures. In addition, it is also shown that extracapsular dissection can be performed in functioning adenomas that invade the suprasellar region. Significantly higher rates of total resection and higher remission rates were observed in cases where extra- and intrapseudocapsular dissection was required.

Asa SL, Ezzat S (1998) The cytogenesis and pathogenesis of pituitary adenomas. Endocr Rev 19:798–827PubMedCrossRef

Bergland R (1975) Pathological considerations in pituitary tumors. Prog Neurol Surg 6:62–94

Campero A, Campero AA, Martins C, Yasuda A, Rhoton AL Jr (2010) Surgical anatomy of the dural walls of the cavernous sinus. J Clin Neurosci 17(6):746–50PubMedCrossRef

Campero A, Martins C, Yasuda A, Rhoton AL Jr (2008) Microsurgical anatomy of the diaphragma sellae and its role in directing the pattern of growth of pituitary adenomas. Neurosurgery 62(3):717–723PubMedCrossRef

Cappabianca P, Cavallo LM, de Divitiis E (2001) Endoscopic endonasal transsphenoidal surgery. J Neurosurg 95(5):917–8

Carrau RL, Kassam AB, Snyderman CH (2001) Pituitary Surgery. Otolaryngol Clin North Am 34(6):1143–1155PubMedCrossRef

Ceylan S, Anik I, Koc K, Kokturk S, Ceylan S, Cine N, Savli H, Sirin G, Sam B, Gazioglu N (2011) Microsurgical anatomy of membranous layers of the pituitary gland and the expression of extracellular matrix collagenous proteins. Acta Neurochir (Wien) 153:2435–2443CrossRef

Ceylan S, Koc K, Anik I (2010) Endoscopic endonasal approach for pituitary adenomas invading the cavernous sinus. J Neurosurg 112(1):99–107PubMedCrossRef

Chacko AG, Chacko G, Seshadri MS, Chandy MJ (2003) The ‘capsule’ of pituitary macroadenomas represents normal pituitary gland: a histopathological study. Br J Neurosurg 17:213–218PubMedCrossRef

10.

Costello RT (1936) Subclinical adenoma of the pituitary gland. Am J Pathol 12:205–216PubMed

11.

Farnoud MR, Kujas M, Derome P, Racadot J, Peillon F, Li JY (1994) Interactions between normal and tumoral tissues at the boundary of human anterior pituitary adenomas. An immunohistichemical study. Virchows Arch 424:75–82PubMedCrossRef

12.

Frank G, Pasquini E, Mazzatena D (2006) Extended transsphenoidal approach. Neurosurg Rev 29(4):298–305CrossRef

13.

Gonçalves MB, de Oliveria JG, Williams HA, Alvarenga RM, Landeiro JA (2012) Cavernous sinus medial wall: dural or fibrous layer? Systematic review of the literature. Neurosurg Rev 35(2):147–53PubMedCrossRef

14.

Gulsen S, Dinc AH, Unal M, Cantürk N, Altinors N (2010) Characterization of the anatomic location of the pituitary stalk and its relationship to the dorsum sellae, tuberculum sellae and chiasmatic cistern. J Korean Neurosurg Soc 47(3):169–173PubMedCrossRef

15.

Hardy J (1975) Transsphenoidal microsurgical removal of pituitary micro-adenoma. Prog Neurol Surg 6:200–216

16.

Hashimoto N, Handa H, Yamagami T (1986) Transsphenoidal extracapsular approach to pituitary tumors. J Neurosurg 64:16–20PubMedCrossRef

17.

Jagannathan J, Smith R, DeVroom HL, Vortmeyer AO, Stratakis CA, Nieman LK, Oldfield EH (2012) Outcome of using the histological pseudocapsule as a surgical capsule in Cushing disease. J Neurosurg 116(4):721–727CrossRef

18.

Jane JA, Laws ER (2001) The surgical management of pituitary adenomas in a series of 3093 patients. J Am Coll Surg 193:650–659CrossRef

19.

Jho H-D, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87:44–51PubMedCrossRef

20.

Kawamata T, Kubo O, Hori T (2005) Surgical removal of growth hormone secreting pituitary adenomas with intensive microsurgical pseudocapsule resection results in complete remission of acromegaly. Neurosurg Rev 28:201–208PubMedCrossRef

21.

Laws E (1995) Transsphenoidal approach to pituitary tumors. In: Schmidek HH, Sweet WH (eds) Operative Neurosurgical Techniques: Indications, Methods, and Results, ed 3, vol 1. WB Saunders, Philadelphia, pp 283–292

22.

Lee EJ, Ahn JY, Noh T, Kim SH, Kim TS (2009) Tumor tissue identification in the pseudocapsule of pituitary adenoma: should the pseudocapsule be removed for total resection of pituitary adenoma? Neurosurgery 64:62–69CrossRef

23.

McCutcheon IE (2013) Pituitary adenomas: Surgery and radiotherapy in the age of molecular diagnostics and pathology. Curr Probl Cancer 37:6–37PubMedCrossRef

24.

Monteith SJ, Starke RM, Jane JA Jr, Oldfield EH (2012) Use of the histological pseudocapsule in surgery for Cushing disease: rapid postoperative cortisol decline predicting complete tumor resection. J Neurosurg 116(4):721–727PubMedCrossRef

25.

Oldfield EH, Vortmeyer AO (2006) Development of a histological pseudocapsule and its use as a surgical capsule in the excision of pituitary tumors. J Neurosurg 104:7–19PubMedCrossRef

26.

Qu X, Yang J, Sun JD, Mou CZ, Wang GD, Han T, Qu YM, Wang M, Xu GM (2011) Transsphenoidal pseudocapsulebased extracapsular resection for pituitary adenomas. Acta Neurochir (Wien) 153(4):799–806CrossRef

27.

Songtao Q, Yuntao L, Jun P, Chuanping H, Xiaofeng S (2009) Membranous layers of the pituitary gland: histological anatomic study and related clinical issues. Neurosurgery 64(3):1–10

28.

Won HS, Han SH, Oh CS, Lee JI, Chung IH, Kim SH (2010) Topographic variations of the optic chiasm and the foramen diaphragma sellae. Surg Radiol Anat 32(7):653–657PubMedCrossRef

29.

Wrightson P (1978) Conservative removal of small pituitary tumours: is it justified by the pathological findings? J Neurol Neurosurg Psychiatry 41:283–289PubMedCrossRef

30.

Xin Q, Guangming X, Yuanming Q, Tao S (2011) The pseudocapsule surrounding a pituitary adenoma and it’s clinical significance. J Neurooncol 101(2):171–178CrossRef

31.

Yasuda A, Campero A, Martins C, Rhoton AL Jr, Ribas GC (2004) The medial wall of the cavernous sinus: microsurgical anatomy. Neurosurgery 55(1):179–190PubMedCrossRef

32.

Zada G, Kelly D, Cohan P, Wang C, Swerdloff R (2003) Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions. J Neurosurg 98:350–358PubMedCrossRef

Title: Endoscopic distinction between capsule and pseudocapsule of pituitary adenomas
Authors: Savas Ceylan
Burak Cabuk
Kenan Koc
Ihsan Anik
Cigdem Vural
Publication date: 01-09-2013
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 9/2013
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-013-1754-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endoscopic distinction between capsule and pseudocapsule of pituitary adenomas

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 9/2013

Long-term neuromechanical results of selective tibial neurotomy in patients with spastic equinus foot

Evaluation of two- and three-dimensional visualization for endoscopic endonasal surgery using a novel stereoendoscopic system in a novice: a comparison on a dry laboratory model

Rostral basilar artery syndrome following transsphenoidal surgery—a report of four cases

The lasting legacy of Sir Victor Horsley

Unusual peroneal nerve palsy caused by intraneural ganglion cyst: pathological mechanism and appropriate treatment

Endoscopic endonasal trans-sphenoidal approach for pituitary adenomas: Is one nostril enough?