Valor predictivo de la clasificación de Knosp en el grado de resección quirúrgica de los macroadenomas invasivos. Estudio prospectivo de una serie de 23 casos
Predicitve value of the Knosp classification in the staging of invasive pituitary macroadenomas. A Prospective study of 23 cases
J. Enseñat
, T. Topcewski, J. Vilalta, J. Sahuquillo
Servicios de Neurocirugía, Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona. España
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"apellidos" => "Topcewski" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Vilalta" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Sahuquillo" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicios de Neurocirugía, Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona. España" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia postal: Cr. Urgell 149- 151 Esc 2a. Ático 1. 08036 Barcelona." ] ] ] 1 => array:3 [ "autoresLista" => "G. Obiols, J. Mesa, A. Ortega" "autores" => array:3 [ 0 => array:3 [ "nombre" => "G." "apellidos" => "Obiols" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Mesa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Ortega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicios de Endocrinología, Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona. España" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff0010" ] 1 => array:3 [ "entidad" => "Servicios de Anatomía Patológica, Hospital Universitario Vall d’Hebron. Universidad Autónoma de Barcelona. España" "etiqueta" => "<span class="elsevierStyleSup">**</span>" "identificador" => "aff0015" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Predicitve value of the Knosp classification in the staging of invasive pituitary macroadenomas. A Prospective study of 23 cases" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2005-12-20" "fechaAceptado" => "2006-02-19" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec159436" "palabras" => array:4 [ 0 => "Macroadenomas invasivos" 1 => "Seno cavernoso" 2 => "Abordaje transesfenoidal" 3 => "Clasificación radiológica" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec159437" "palabras" => array:4 [ 0 => "Invasive macroadenomas" 1 => "Cavernous sinus" 2 => "Transsphenoidal approach" 3 => "Radiologic classification" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar y valorar el grado de resección y las complicaciones de la cirugía transesfenoidal en una serie de 23 casos de macroadenomas con invasión del seno cavernoso evaluados mediante la clasificación de Knosp.</p> <span class="elsevierStyleSectionTitle">Material, métodos y resultados</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de 22 pacientes (23 operaciones) intervenidos en nuestro centro entre Mayo del 2002 y Diciembre del 2004 de macroadenomas hipofisarios con diferentes grados de invasión del seno cavernoso según la clasificación de Knosp15. Entre las variables del estudio se incluyeron los grados de invasión y de resección postoperatoria con un seguimiento radiológico medio a largo plazo de 15 meses.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Nuestra serie consta de 15 varones y 7 mujeres, con una edad media de 48 años (27 – 75 años). Todos ellos presentaban macroadenomas con afectación de uno o ambos senos cavernosos. De acuerdo con la clasificación de Knosp 4 pacientes fueron grado 1, 2 grado 2, 1 grado 3 y 16 grado 4. En 20 casos se utilizó una vía transesfenoidal clásica y en tres casos se hizo un abordaje transesfenoidal endoscópico. Según la RMN postoperatoria los grados de resección fueron: completo o total en todos los pacientes con grados 1 y 2 y en sólo 2 pacientes con grado 4; subtotal (>80%) en 1 paciente con grado 3 y en 6 pacientes con grado 4 y parcial (<80%) en 7 pacientes con grado 4 de Knosp. Se compararon los grados de resección versus los grados de invasión mediante el Test exacto de Fisher y las diferencias no fueron estadísticamente significativas (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.12).</p> <span class="elsevierStyleSectionTitle">Discusión y conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Si bien únicamente la clasificación radiológica de Knosp por si sola no puede predecir el comportamiento biológico del tumor o si la pared medial del seno cavernoso está infiltrada o desplazada, en nuestra serie los tumores de grado 4 han sido los que han presentado un peor resultado de acuerdo al grado de resección. En los tumores que invaden el seno cavernoso, incluso en los casos donde la carótida está englobada es posible realizar resecciones completas con una morbimortalidad aceptable.</p>" ] "en" => array:2 [ "titulo" => "Summary" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To evaluate our experience regarding the treatment of pituitary macroadenomas with cavernous sinus invasion in a series of 23 cases of transphenoidal resection.</p> <span class="elsevierStyleSectionTitle">Materials, methods and results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Twenty two patients, fifteen males and seven females, with ages ranging from 27 to 75 (mean of 48), were operated under protocol by a single surgeon between May of 2002 and December of 2004. Preoperatively all lesions were diagnosed by MRI and staged according to the Knosp classification. All tumors had extension to one or both cavernous sinuses. Four patients were considered to be grade 1, two grade 2, one grade 3 and sixteen grade 4. Twenty three operations were performed on twenty-two patients. Twenty cases were the standard transsphenoidal approach, and three were endoscopic. Postoperatively, the excision was classified as Complete or Total, Subtotal or Partial. Mean follow up was 15 months. The variables considered for analysis include invasion and resection grades. All six patients with graded 1 and 2 lesions and two patients with grade 4 lesions underwent a complete resection. Subtotal (greater than 80%) excision was achieved in one patient with a grade 3 tumor and six patients with grade 4 tumors. The remaining seven patients with grade 4 adenomas had a Partial (less than 80%) excision. We compare de resection grade versus invasion grade with exact Fisher test. And there is not estadistical difference (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.12).</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The Knosp classification alone cannot predict the behavior of these tumors. In our experience, despite tumor extension to the cavernous sinus, pituitary macroadenomas can be safely resected with low morbidity and mortality.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Enseñat, J.; Ortega, A.; Topcewski, T.; Vilalta, J.; Obiols, G.; Mesa, J.; Sahuquillo, J.: Valor predictivo de la clasificación de Knosp en el grado de resección quirúrgica de los macroadenomas invasivos. Estudio prospectivo de una serie de 23 casos. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 72 | 5 | 77 |
| 2022 Enero | 1 | 2 | 3 |
| 2021 Noviembre | 1 | 0 | 1 |
| 2020 Julio | 1 | 0 | 1 |
| 2020 Junio | 0 | 2 | 2 |
| 2020 Mayo | 0 | 2 | 2 |
| 2019 Julio | 1 | 0 | 1 |
| 2018 Marzo | 28 | 13 | 41 |
| 2018 Febrero | 37 | 13 | 50 |
| 2018 Enero | 35 | 20 | 55 |
| 2017 Diciembre | 33 | 18 | 51 |
| 2017 Noviembre | 45 | 30 | 75 |
| 2017 Octubre | 45 | 23 | 68 |
| 2017 Septiembre | 30 | 24 | 54 |
| 2017 Agosto | 37 | 27 | 64 |
| 2017 Julio | 36 | 20 | 56 |
| 2017 Junio | 58 | 38 | 96 |
| 2017 Mayo | 42 | 17 | 59 |
| 2017 Abril | 29 | 34 | 63 |
| 2017 Marzo | 31 | 23 | 54 |
| 2017 Febrero | 37 | 68 | 105 |
| 2017 Enero | 33 | 33 | 66 |
| 2016 Diciembre | 45 | 27 | 72 |
| 2016 Noviembre | 38 | 56 | 94 |
| 2016 Octubre | 60 | 55 | 115 |
| 2016 Septiembre | 160 | 81 | 241 |
| 2016 Agosto | 103 | 61 | 164 |
| 2016 Julio | 44 | 23 | 67 |
| 2016 Junio | 1 | 0 | 1 |
| 2016 Mayo | 2 | 0 | 2 |
| 2016 Marzo | 2 | 0 | 2 |
| 2015 Diciembre | 3 | 0 | 3 |
| 2015 Julio | 5 | 0 | 5 |
| 2015 Junio | 49 | 12 | 61 |
| 2015 Mayo | 56 | 15 | 71 |
| 2015 Abril | 67 | 12 | 79 |
| 2015 Marzo | 54 | 15 | 69 |
| 2015 Febrero | 70 | 11 | 81 |
| 2015 Enero | 45 | 8 | 53 |
| 2014 Diciembre | 44 | 9 | 53 |
| 2014 Noviembre | 42 | 11 | 53 |
| 2014 Octubre | 47 | 16 | 63 |
| 2014 Septiembre | 53 | 11 | 64 |
| 2014 Agosto | 35 | 17 | 52 |
| 2014 Julio | 42 | 14 | 56 |
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| 2014 Marzo | 43 | 13 | 56 |
| 2014 Febrero | 34 | 22 | 56 |
| 2014 Enero | 37 | 18 | 55 |
| 2013 Diciembre | 37 | 13 | 50 |
| 2013 Noviembre | 42 | 17 | 59 |
| 2013 Octubre | 36 | 20 | 56 |
| 2013 Septiembre | 32 | 40 | 72 |
| 2013 Agosto | 38 | 46 | 84 |
| 2013 Julio | 30 | 14 | 44 |
| 2013 Junio | 30 | 22 | 52 |
| 2013 Mayo | 30 | 27 | 57 |
| 2013 Abril | 24 | 17 | 41 |
| 2013 Marzo | 31 | 27 | 58 |
| 2013 Febrero | 16 | 17 | 33 |
| 2013 Enero | 22 | 19 | 41 |
| 2012 Diciembre | 17 | 24 | 41 |
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| 2012 Octubre | 0 | 2 | 2 |
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| 2012 Enero | 8 | 0 | 8 |
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