Transsphenoidal pseudocapsule-based extracapsular resection for pituitary adenomas

Acta Neurochir (2011) 153:799–806. DOI 10.1007/s00701-011-0961-1

In the past several years, increasing attention has been paid to the utility of a pseudocapsule in transphenoidal surgery for pituitary adenomas. However, prior studies focused more on the histological structure of the pseudocapsule and surgical technique. The objective of this study was to evaluate the overall therapeutic effectiveness of transsphenoidal pseudocapsule-based extracapsular resection for pituitary adenomas.

Methods Between January 2004 and October 2007, 78 patients with pituitary adenomas underwent transsphenoidal pseudocapsule-based extracapsular removal surgery (extracapsular resection group, ER group). During the same period, 64 patients underwent transsphenoidal intracapsular resection operations (intracapsular resection group, IR group).

Results Complete resection rates were achieved in 90.6%, 84.6% and 65.5%, 52.6% of modified Hardy types II and III in the ER and IR groups, showing a significant difference (both P<0.05). Statistical significance in the remission rates was also found between the two groups with modified Hardy types II and III, respectively (both P<0.05). Complications occurred in 29.5% of the ER group and 26.6% of the IR group, with no difference between groups (P>0.05). The recurrence rate of the ER group (2.56%) was lower than that of the IR group (14.06%).

Conclusion The transsphenoidal pseudocapsule-based extracapsular resection approach provides a more effective and safe alternative compared to the traditional intracapsular one because of its higher tumor removal and remission rates, and lower recurrence rate.