Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Management of Patients with Nonfunctioning Pituitary Adenomas: Executive Summary

Manish K. Aghi, Clark C. Chen, Maria Fleseriu, Steven A. Newman, Joshua William Lucas, John S. Kuo, Garni Barkhoudarian, Christopher J. Farrell, Jason Sheehan, Mateo Ziu, Ian F. Dunn

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

BACKGROUND: Nonfunctioning pituitary adenomas (NFPAs) are the most frequent pituitary tumors. OBJECTIVE: To create evidence-based guidelines for the initial management of NFPAs. METHODS: A multidisciplinary task force composed of physician volunteers and evidence-based medicine-trained methodologists conducted a systematic review of the literature relevant to the management of NFPAs. To ascertain the class of evidence for the posttreatment follow-ups, the task force used the Clinical Assessment evidence-based classification. RESULTS: Seven topics of importance were chosen for detailed evaluation. The topics addressed include preoperative evaluation, primary treatment, treatment options for residual tumors after surgery, and postoperative patient management. For preoperative patient evaluation, the guideline task force focused on preoperative imaging, preoperative laboratory evaluation, and preoperative ophthalmologic evaluation. For primary treatment, this guideline addresses surgical resection, medical therapy, radiation therapy, the natural history of untreated tumors, surgical methodologies, such as endoscopy, microscopy, or craniotomy, and intraoperative adjuncts like neuronavigation, cerebrospinal fluid diversion, or intraoperative imaging. For residual tumor treatment, the guideline task force evaluated radiation vs observation. Additional topics addressed in this guideline regarding postoperative patient management include the frequency of postoperative imaging, postoperative endocrine evaluation, and postoperative ophthalmologic evaluation. CONCLUSION: Although there is clearly a need for more randomized trials generating higher levels of evidence to help guide physicians managing NFPAs, the existing evidence provided valuable data upon which the guidelines described in the 7 articles generated from this effort are based. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas.

Original languageEnglish (US)
Pages (from-to)521-523
Number of pages3
JournalNeurosurgery
Volume79
Issue number4
DOIs
StatePublished - Oct 1 2016

Fingerprint

Pituitary Neoplasms
Guidelines
Advisory Committees
Residual Neoplasm
Neuronavigation
Physicians
Therapeutics
Craniotomy
Evidence-Based Medicine
Endoscopy
Cerebrospinal Fluid
Volunteers
Microscopy
Radiotherapy
Observation
Radiation

Keywords

  • Guidelines
  • Nonfunctioning pituitary adenoma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Management of Patients with Nonfunctioning Pituitary Adenomas : Executive Summary. / Aghi, Manish K.; Chen, Clark C.; Fleseriu, Maria; Newman, Steven A.; Lucas, Joshua William; Kuo, John S.; Barkhoudarian, Garni; Farrell, Christopher J.; Sheehan, Jason; Ziu, Mateo; Dunn, Ian F.

In: Neurosurgery, Vol. 79, No. 4, 01.10.2016, p. 521-523.

Research output: Contribution to journalReview article

Aghi, Manish K. ; Chen, Clark C. ; Fleseriu, Maria ; Newman, Steven A. ; Lucas, Joshua William ; Kuo, John S. ; Barkhoudarian, Garni ; Farrell, Christopher J. ; Sheehan, Jason ; Ziu, Mateo ; Dunn, Ian F. / Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Management of Patients with Nonfunctioning Pituitary Adenomas : Executive Summary. In: Neurosurgery. 2016 ; Vol. 79, No. 4. pp. 521-523.
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abstract = "BACKGROUND: Nonfunctioning pituitary adenomas (NFPAs) are the most frequent pituitary tumors. OBJECTIVE: To create evidence-based guidelines for the initial management of NFPAs. METHODS: A multidisciplinary task force composed of physician volunteers and evidence-based medicine-trained methodologists conducted a systematic review of the literature relevant to the management of NFPAs. To ascertain the class of evidence for the posttreatment follow-ups, the task force used the Clinical Assessment evidence-based classification. RESULTS: Seven topics of importance were chosen for detailed evaluation. The topics addressed include preoperative evaluation, primary treatment, treatment options for residual tumors after surgery, and postoperative patient management. For preoperative patient evaluation, the guideline task force focused on preoperative imaging, preoperative laboratory evaluation, and preoperative ophthalmologic evaluation. For primary treatment, this guideline addresses surgical resection, medical therapy, radiation therapy, the natural history of untreated tumors, surgical methodologies, such as endoscopy, microscopy, or craniotomy, and intraoperative adjuncts like neuronavigation, cerebrospinal fluid diversion, or intraoperative imaging. For residual tumor treatment, the guideline task force evaluated radiation vs observation. Additional topics addressed in this guideline regarding postoperative patient management include the frequency of postoperative imaging, postoperative endocrine evaluation, and postoperative ophthalmologic evaluation. CONCLUSION: Although there is clearly a need for more randomized trials generating higher levels of evidence to help guide physicians managing NFPAs, the existing evidence provided valuable data upon which the guidelines described in the 7 articles generated from this effort are based. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas.",
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T2 - Executive Summary

AU - Aghi, Manish K.

AU - Chen, Clark C.

AU - Fleseriu, Maria

AU - Newman, Steven A.

AU - Lucas, Joshua William

AU - Kuo, John S.

AU - Barkhoudarian, Garni

AU - Farrell, Christopher J.

AU - Sheehan, Jason

AU - Ziu, Mateo

AU - Dunn, Ian F.

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N2 - BACKGROUND: Nonfunctioning pituitary adenomas (NFPAs) are the most frequent pituitary tumors. OBJECTIVE: To create evidence-based guidelines for the initial management of NFPAs. METHODS: A multidisciplinary task force composed of physician volunteers and evidence-based medicine-trained methodologists conducted a systematic review of the literature relevant to the management of NFPAs. To ascertain the class of evidence for the posttreatment follow-ups, the task force used the Clinical Assessment evidence-based classification. RESULTS: Seven topics of importance were chosen for detailed evaluation. The topics addressed include preoperative evaluation, primary treatment, treatment options for residual tumors after surgery, and postoperative patient management. For preoperative patient evaluation, the guideline task force focused on preoperative imaging, preoperative laboratory evaluation, and preoperative ophthalmologic evaluation. For primary treatment, this guideline addresses surgical resection, medical therapy, radiation therapy, the natural history of untreated tumors, surgical methodologies, such as endoscopy, microscopy, or craniotomy, and intraoperative adjuncts like neuronavigation, cerebrospinal fluid diversion, or intraoperative imaging. For residual tumor treatment, the guideline task force evaluated radiation vs observation. Additional topics addressed in this guideline regarding postoperative patient management include the frequency of postoperative imaging, postoperative endocrine evaluation, and postoperative ophthalmologic evaluation. CONCLUSION: Although there is clearly a need for more randomized trials generating higher levels of evidence to help guide physicians managing NFPAs, the existing evidence provided valuable data upon which the guidelines described in the 7 articles generated from this effort are based. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas.

AB - BACKGROUND: Nonfunctioning pituitary adenomas (NFPAs) are the most frequent pituitary tumors. OBJECTIVE: To create evidence-based guidelines for the initial management of NFPAs. METHODS: A multidisciplinary task force composed of physician volunteers and evidence-based medicine-trained methodologists conducted a systematic review of the literature relevant to the management of NFPAs. To ascertain the class of evidence for the posttreatment follow-ups, the task force used the Clinical Assessment evidence-based classification. RESULTS: Seven topics of importance were chosen for detailed evaluation. The topics addressed include preoperative evaluation, primary treatment, treatment options for residual tumors after surgery, and postoperative patient management. For preoperative patient evaluation, the guideline task force focused on preoperative imaging, preoperative laboratory evaluation, and preoperative ophthalmologic evaluation. For primary treatment, this guideline addresses surgical resection, medical therapy, radiation therapy, the natural history of untreated tumors, surgical methodologies, such as endoscopy, microscopy, or craniotomy, and intraoperative adjuncts like neuronavigation, cerebrospinal fluid diversion, or intraoperative imaging. For residual tumor treatment, the guideline task force evaluated radiation vs observation. Additional topics addressed in this guideline regarding postoperative patient management include the frequency of postoperative imaging, postoperative endocrine evaluation, and postoperative ophthalmologic evaluation. CONCLUSION: Although there is clearly a need for more randomized trials generating higher levels of evidence to help guide physicians managing NFPAs, the existing evidence provided valuable data upon which the guidelines described in the 7 articles generated from this effort are based. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-non-functioning-pituitary-adenomas.

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