With over 200 surgeries performed annually, and a long history of neurosurgical innovation, the California Center for Pituitary Disorders (CCPD) at UCSF is one of the highest volume centers for pituitary surgery in the world.
Facility volume continues to prove a strong, independent factor in improving patient outcomes – most recently demonstrated in a study led by CCPD neurosurgeon Manish Aghi, MD, PhD, examining surgical outcomes for giant pituitary adenomas.1 Despite their benign profile, giant pituitary adenomas, which are defined as being 4 cm or greater at their maximum diameter, can cause serious complications and remain a complex neurosurgical challenge.
The authors found that treatment at a facility performing at least 2.5 pituitary adenoma procedures each year had a strong effect in reducing rates of 30- and 90-day postoperative mortality, readmission, and prolonged length of inpatient hospital stay.
These results, along with consistent findings from other studies 2-4, demonstrate a strong relationship between physician experience and better outcomes for patients and suggest the value of physicians at different institutions collaborating to care for patients with large tumors and other uncommon conditions.
Largest case series to date identifies risk factors for diabetes insipidus
UCSF’s high case volume also puts the CCPD in a unique position for advancing research on pituitary disorders.
Another recent study by CCPD physician-scientists characterized predictors of diabetes insipidus, the most common type of postoperative morbidity following transsphenoidal surgery. Over 2500 patients treated at the CCPD between 2007 and 2019 were included in the study, making this the largest series to date of patients treated by transsphenoidal surgery for sellar lesions at a single institution.
From this cohort, the authors identified several preoperative risk factors for diabetes insipidus in patients undergoing surgery on pituitary adenomas, including younger age and increased adenoma diameter.5 Intraoperative CSF encounter, craniopharyngioma diagnosis, and postoperative hyponatremia were also associated with higher rates of diabetes insipidus.
These criteria may help physicians adjust their treatment paradigms to ensure early recognition and treatment of diabetes insipidus following transsphenoidal surgery.
References
1. Chalif EJ, Couldwell WT, Aghi MK. Effect of facility volume on giant pituitary adenoma neurosurgical outcomes. J Neurosurg. 2022; Jan 14:1-10.
2. Barker FG 2nd, Klibanski A, Swearingen B. Transsphenoidal surgery for pituitary tumors in the United States, 1996-2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin Endocrinol Metab. 2003;88(10):4709-19.
3. Casanueva FF, Barkan AL, Buchfelder M, Klibanski A, Laws ER, Loeffler JS, Melmed S, Mortini P, Wass J, Giustina A; Pituitary Society, Expert Group on Pituitary Tumors. Criteria for the definition of Pituitary Tumor Centers of Excellence (PTCOE): A Pituitary Society Statement. Pituitary. 2017;20(5):489-98.
4. McLaughlin N, Laws ER, Oyesiku NM, Katznelson L, Kelly DF. Pituitary centers of excellence. Neurosurgery. 2012;71(5):916-26.
5. Joshi RS, Pereira MP, Osorio RC, Oh T, Haddad AF, Pereira KM, Donohue KC, Peeran Z, Sudhir S, Jain S, Beniwal A, Chandra A, Han SJ, Rolston JD, Theodosopoulos PV, Kunwar S, Blevins LS, Aghi MK. Identifying risk factors for postoperative diabetes insipidus in more than 2500 patients undergoing transsphenoidal surgery: a single-institution experience. J Neurosurg. 2022 Jan 28:1-11.