title: Time to Revive the Value of the Pseudocapsule in Endoscopic Endonasal Transsphenoidal Surgery for Growth Hormone Adenomas.
abstract: To investigate the role of endoscopic endonasal transsphenoidal surgery and the pseudocapsule in the treatment of growth hormone adenomas.
  
  
  
  The study included 43 patients (age range, 21-64 years) with growth hormone adenomas treated with an endoscopic endonasal approach. We compared the tumor characteristics and surgical outcomes of cases with (group A, 21 cases, from November 2013 to January 2015) and without (group B, 22 cases, from October 2011 to October 2013) extra-pseudocapsule resection.
  
  
  
  The preoperative demographics, tumor characteristics, and surgical complications were not significantly different between groups A and B. Postoperative remission without adjuvant therapy was achieved in 18 of 21 cases (85.7%) in group A, which was significantly greater than that observed in group B (12 of 22 cases [54.4%]). In group A, the pseudocapsules were verified by endoscopy and histopathology. The pseudocapsule was removed en bloc with the whole adenoma in only 5 cases (23.8%). For the remaining 16 patients (76.2%), following extra-pseudocapsule dissection, incomplete pseudocapsule removals with intracapsule procedures were achieved.
  
  
  
  The combination of extra-pseudocapsule resection and endoscopy led to a high rate of gross total tumor resection and endocrinologicl remission in acromegalic patients compared with the group with intracapsular resection. Extra-pseudocapsule resection resulted in no additional postoperative complications.
authors.affiliation: Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Xie
authors.affiliation: Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Tengfei
authors.initials: T
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China; Digital Medical Research Center, Fudan University, Shanghai, China; Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, China. Electronic address: xiaobiao_zhang@163.com.
authors.forename: Xiaobiao
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Lingli
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Rongkui
authors.initials: R
authors.lastname: Luo
authors.affiliation: Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Sun
authors.affiliation: Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Hu
authors.affiliation: Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Gu
authors.affiliation: Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Lu
mesh_terms: D000172:Acromegaly / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D000236:Adenoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D019382:Human Growth Hormone / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000009:adverse effects / Q000379:methods*; D009666:Nose; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D013100:Sphenoid Bone; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone
keywords: Acromegaly; Endoscopic pituitary surgery; Pituitary adenoma; Pseudocapsule