title: Impact of selective pituitary gland incision or resection on hormonal function after adenoma or cyst resection.
abstract: OBJECTIVE
  With the resection of pituitary lesions, the anterior pituitary gland often obstructs transsphenoidal access to the lesion. In such cases, a gland incision and/or partial gland resection may be required to obtain adequate exposure. We investigate this technique and determine the associated risk of post-operative hypopituitarism.
  
  
  METHODS
  All patients who underwent surgical resection of a pituitary adenoma or Rathke cleft cyst (RCC) between July 2007 and January 2013 were analyzed for pre- and post-operative hormone function. The cohort of patients with gland incision/resection were compared to a case-matched control cohort of pituitary surgery patients. Total hypophysectomy patients were excluded from outcome analysis.
  
  
  RESULTS
  Of 372 operations over this period, an anterior pituitary gland incision or partial gland resection was performed in 79 cases (21.2 %). These include 53 gland incisions, 12 partial hemi-hypophysectomies and 14 resections of thinned/attenuated anterior gland. Diagnoses included 64 adenomas and 15 RCCs. New permanent hypopituitarism occurred in three patients (3.8 %), including permanent DI (3) and growth hormone deficiency (1). There was no significant difference in the rate of worsening gland dysfunction nor gain of function. Compared to a control cohort, there was a significantly lower incidence of transient DI (1.25 vs. 11.1 %, p = 0.009) but no significant difference in permanent DI (3.8 vs. 4.0 %) in the gland incision group.
  
  
  CONCLUSIONS
  Selective gland incisions and gland resections were performed in over 20 % of our cases. This technique appears to minimize traction on compressed normal pituitary gland during removal of large lesions and facilitates better visualization and removal of cysts, microadenomas and macroadenomas.
authors.affiliation: Pacific Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA, USA. barkhoudariang@jwci.org.
authors.forename: Garni
authors.initials: G
authors.lastname: Barkhoudarian
authors.affiliation: Inland Neurosurgery Institute, Pomona, CA, USA.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Cutler
authors.affiliation: Wayne State Medical School, Detroit, MI, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Yost
authors.affiliation: Pacific Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA, USA.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Lobo
authors.affiliation: Pacific Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA, USA.
authors.forename: Amalia
authors.initials: A
authors.lastname: Eisenberg
authors.affiliation: Pacific Brain Tumor Center and Pituitary Disorders Program, John Wayne Cancer Institute, Saint John's Health Center, Santa Monica, CA, USA.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Kelly
mesh_terms: D000328:Adult; D020863:Central Nervous System Cysts / Q000601:surgery*; D003919:Diabetes Insipidus / Q000209:etiology; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010902:Pituitary Gland / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000601:surgery*; D011184:Postoperative Period; D016896:Treatment Outcome
keywords: Diabetes insipidus; Hypopituitarism; Pituitary adenoma; Rathke cleft cyst; Transsphenoidal surgery