Predictors of endoscopic transsphenoidal surgery outcome in acromegaly: patient and tumor characteristics evaluated by magnetic resonance imaging.

The availability of various first-line treatment modalities for acromegaly and evolving surgical techniques emphasize the need for accurately defined predictors of surgical outcome. We retrospectively analysed the outcome of 30 patients with acromegaly after initial endoscopic transsphenoidal surgery in two university hospitals from 2001 until 2009, and reviewed comparable literature investigating predictive tumor characteristics. Medical records were monitored for patient characteristics. Each pituitary magnetic resonance imaging (MRI) scan was revised independently by two neuroradiologists using a standardised analysis form to record distinctive predefined tumor characteristics. All characteristics were independently analysed as predictors for persistent disease, and a multivariable predictive model was created. Literature from 2000 onwards was searched for studies describing tumor characteristics predictive for surgical outcome. The cohort consisted of 27 macroadenomas with 90 % demonstrating signs of parasellar extension. The surgical cure rate overall was 30 %. Independently, next to male sex and increasing tumor size, infrasellar and parasellar extension based on MRI staging tended to increase the risk of persistent disease. In a multivariable analysis, sex and parasellar extension of the tumor were demonstrated to be the variables allowing for the best fitted predictive model for persistent disease. Earlier studies on preoperative tumor characteristics showed comparable results, although these were based on several different tumor classification systems. This retrospective study demonstrates that accurately defined tumor characteristics based on imaging, especially for cavernous sinus invasion, can be helpful in predicting surgical outcome. Comparative studies on different treatment modalities are essential for clinical practice within the scope of re-evaluation of the role of surgery in GH-secreting adenomas.

Radiologic extranodal spread and matted nodes: Important predictive factors for development of distant metastases in patients with high-risk head and neck cancer.

BACKGROUND: Different clinical high-risk factors for the development of distant metastases have been identified but not tested in the same cohort of patients with head and neck squamous cell carcinoma (HNSCC). METHODS: In 145 patients with previously identified clinical high risk factors, the presence of extranodal spread (ENS) and matted node on pretreatment CT (n = 96) and/or MRI (n = 111) were determined. RESULTS: Of 145 patients, ENS was detected in 87 patients (60.0%) and matted nodes in 53 patients (36.6%). Kaplan-Meier curves for presence or absence of ENS (on CT and/or MRI) and matted nodes (on CT) differ significantly. In a Cox regression analysis, only ENS was a significant risk factor (hazard ratio [HR] = 3.3; 95% confidence interval [CI] = 2.0-5.5; p < .001). CONCLUSION: In patients with high-risk HNSCC with clinically (palpably or radiologically) ENS and matted nodes, both determined radiologically, are high risk factors for development of distant metastases. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1452-E1458, 2016.

[Glossopharyngeal neuralgia and syncope]. / Een man met glossopharyngeusneuralgie en syncope.

BACKGROUND: The causes of neuralgia are usually not known, but the condition can be caused by an underlying condition. CASE DESCRIPTION: A 58-year-old man presented at the accident and emergency department with a 6-week history of continuous nagging pain in the region of his right ear, extending to the lower jaw and the right side of his neck; this worsened in progressive attacks, which were sometimes followed by non-rotatory dizziness and loss of consciousness. This clinical picture lead us to suspect glossopharyngeal neuralgia (GPN) because of the distribution of the pain and the secondary syncope, but the continuous nature of the pain was atypical and a reason for further investigation. This revealed metastatic parotid gland carcinoma with compression of the right glossopharyngeal nerve. Following palliative radiotherapy, the pain improved and there were no further episodes of loss of consciousness. CONCLUSION: When GPN is suspected and there is continuous pain, or neurological investigations reveal abnormalities, an underlying condition should be considered and additional investigations should be carried out.