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This article examines the impact of the COVID-19 pandemic on endoscopic pituitary surgery at a pituitary center of excellence. The study compared patients who underwent surgery before the pandemic (January 2015 to March 2020) with those who had surgery during the pandemic (March 2020 to September 2022). The results showed that patients who presented during the pandemic tended to be more frail and have more comorbidities. They were also more likely to have larger adenomas and require additional surgical approaches. Despite these changes, the length of stay and readmission rate remained stable, indicating the safety of the procedure during the pandemic. [Extracted from the article]

This article discusses the outcomes of the endoscopic endonasal approach (EEA) for nonfunctional pituitary adenomas (NFPAs) in elderly patients. The study involved a retrospective review of NFPAs in patients aged 65 and older who underwent EEA between 2007 and 2022 at a single medical center. The results showed that EEA was a safe and effective option for NFPA resection in elderly patients, with high rates of visual recovery postoperatively and acceptable rates of gross total resection (GTR). The study also identified risk factors for progression and subtotal resection, but found no associations between postoperative complications and age or frailty scores. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, introduces a novel outcome metric called the 30-day hospitalization ratio (HR) for patients with pituitary adenomas. The metric combines the length of stay and readmission rates within a 30-day period to provide a comprehensive measure of the economic burden of treatment. The study analyzed the clinical records of 468 patients who underwent endoscopic endonasal surgery for pituitary adenoma. Factors associated with a high HR included high preoperative ASA scores, postoperative lumbar drain placement, intradural extension, and employment status. Understanding these risk factors can lead to personalized monitoring and care, ultimately reducing burden and improving outcomes. [Extracted from the article]

Crooke cell adenomas (CCAs) are a rare, aggressive subset of secretory pituitary corticotroph adenomas (sCTAs) found in 5%–10% of patients with Cushing disease. Multiple studies support worse outcomes in CCAs but are limited by small sample size and single-institution databases. We compared outcomes in CCA and sCTA using a multicenter, international retrospective database of high-volume skull base centers. Patients surgically treated for pituitary adenoma from January 2017 through December 2020 were included. Among 2826 patients from 12 international centers, 20 patients with CCA and 480 patients with sCTA were identified. No difference in baseline demographics, tumor characteristics, or postoperative complications was seen. Microsurgical approaches (60% CCA vs. 62.3% sCTA) were most common. Gross total resection was higher in CCA patients (100% vs. 83%, P = 0.05). Among patients with gross total resection according to intraoperative findings, fewer CCA patients had postoperative hormone normalization of pituitary function (50% vs. 77.8%, P < 0.01) and remission of hypersecretion by 3–6 months (75% vs. 84.3%, P < 0.01). This was the case despite CCA having better local control rates (100% vs. 96%, P < 0.01) and fewer patients with remnant on magnetic resonance imaging (0% vs. 7.2%, P < 0.01). A systematic literature review of 35 studies reporting on various treatment strategies reiterated the high rate of residual tumor, persistent hypercortisolism, and tumor-related mortality in CCA patients. This modern, multicenter series of patients with CCA reflects their poor prognosis and reduced postsurgical hormonal normalization. Further work is necessary to better understand the pathophysiology of CCA to devise more targeted treatment approaches. [ABSTRACT FROM AUTHOR]