Table 5.
Results of Studies Evaluating the Outcome of Repeat Pituitary Surgery for Persistent or Recurrent CD
| First Author, Year (Ref.) | No. of Patients | Follow-Up, mo | Remission Rate, % | Recurrence Rate, % | Time to Recurrence, mo | Perioperative Mortality and Complications |
|---|---|---|---|---|---|---|
| Nakane, 1987 (104) | 8 | NA | 87.5 | NA | NA | NA |
| Friedman, 1989 (271)§ | 31 | M:10.1 | 71 | 13.6/9.7 | R:10–47 M:22.3 m:10 |
Death:3.2%; TDI:9.7%; hypopituitarism:24.2%; meningitis:8.2%; PDI:3.2%; CSF:3.2% |
| Ram, 1994 (147) | 17 | R:4–84 M:34 |
70.6 | 25 | M:13.7 m:12 |
Death:0%; hypopituitarism:41.2%; hypothyroidism:11.8%; hypogonadism:11.8%; PDI:17.6%; CSF:17.6% |
| Chee, 2001 (170) | 13 | NA | 38.5 | 60 | NA | Death:0%; CSF:46.2% |
| Shimon, 2002 (160) | 13 | M:50.4 | 61.5 | 0 | na | NA |
| Benveniste, 2005 (272) | 44 | NA | 54.5 | 25 | M:31 | Death:0%; hypopituitarism:66%;a panhypopituitarim:65%;a PDI:28%;a TDI:19%;a sinusitis:5%;a CSF:1%;a epistaxis:1%;a CNP:1%a |
| Locatelli, 2005 (148) | 12 | R:4–76 M:27 |
66.7 | 0 | na | Death:0%; CSF:83.3%; panhypopituitarism:83.3%; PDI: 83.3%; meningitis:8.3%; PE:8.3%; DVT:8.3% |
| Hofmann, 2006 (273) | 16 | M:23 | 43.7 | 0 | na | Death:0% |
| Esposito, 2006 (123)¶ | 11 | M:20 | 45 | 9.1 | 21 | Death:0%; PDI:9.1%; carotid artery injury:9.1%; hypopituitarism:9.1% |
| Hofmann, 2008 (171) | 59 | M:122 | 30.5 | 15.4 | NA | NA |
| Patil, 2008 (274)§ | 36 | m:24 | 61.1 | 9.1/5.5 | R:6–11 M:8.5 |
Death:0%; PDI:11.1%; panhypopituitarism:5.5%; TDI:5.5% |
| Wagenmakers, 2009 (275) | 14 | M:34 m:24 |
71.4 | 0 | na | Death:0%; hypopituitarism:78.6%; hypothyroidism:57.1%; TDI:42.8%; CSF:14.2%; GHD:28.6%; hypogonadism:21.4%; carotid artery damage:7.1%; bleeding:7.1% |
| Hameed, 2013 (149) | 10 | M:21.9 | 70 | 0 | na | Death:0%; DI:30% |
| Alexandraki, 2013 (135) | 22 | R:72–432 M:185 |
50 | 4.5 | M:48 | NA |
| Berker, 2013 (136)¶ | 25 | R:5–75 M:32 |
76 | 6.7 | 12 | Death:0%;b TDI:7.8%;b meningitis:2.2%;b panhypopituitarism:2.2%;b CSF:2.2%b |
| Dimopoulou, 2014 (166) | 36 | M:62 | 41.7 | 40 | M:42 | NA |
| Valderrabano, 2014 (276) | 26 | R:62–184 M:139 |
46.1 | 50 | M:13 | Death:0%; hypopituitarism:37%; TDI:34.6%; hypothyroidism:21%; GHD:21%; hypogonadism:16%; CSF:7.7%; panhypopituitarism:5.2%; meningitis:3.8% |
| Total | 393 |
R:4–432 M:59.8 |
R:30–87.5 M:58 m:61.1 |
R:0–60 M:16.1 m:9.1 |
M:25.5 | Death:R:0–3.2, M:0.3, m:0; PDI:R:3.2–83.3, M:24.7, m:11.1; TDI:R:5.5–42.8, M:23.1, m:22.1; CSF:R:3.2–83.3, M:28.7, m:15.9; meningitis:R:3.8–8.3, M:6.8, m:8.2; hypopituitarism:R:9.1–78.6, M:38, m:37; hypothyroidism:R:11.8–57.1, M:30, m:21; hypogonadism:R:11.8–21.4, M:16.4, m:16; GHD:R:21–28.6, M:24.8, m:24.8; panhypopituitarism:R:5.2–83.3, M:31.3, m:5.5 |
Abbreviations: DI: diabetesinsipidus; TDI: transient diabetes insipidus; PDI: permanent diabetes insipidus; CSF: cerebrospinal fluid; DVT: deep venous thrombosis; PE: pulmonary embolism; CNP: cranial nerve palsy; GHD: GH deficiency; NA, not available; na, not applicable; R, range; M, mean; m, median. This table lists the studies addressing the outcome of repeat pituitary surgery published between 1987 and 2014, including those whose entire content was fully available for the authors. The last line (total) includes the general range and the “average” mean and median values of the different parameters included in the studies, considering exclusively those where these parameters were available and were clearly attributable to the only patients with CD and to the only repeat surgery. The range, mean and median percentage of the adverse effects, including hypopituitarism and diabetes insipidus, were calculated considering the only studies were the specific side effect was reported. In the studies marked with ¶ only 1 patient presented a recurrence, so that the time to recurrence is represented by a single time period, instead of a range, mean, or median. In the studies marked with § the values reported after the/describe the recurrence rate and the time to recurrence for a longer follow-up cohort, in line with the description included in the study; such values were not considered with regard to the total calculations.
Results in 96 patients.
Results including patients with initial surgery.