Cognitive functioning in patients with nonfunctioning pituitary adenoma before and after endoscopic endonasal transsphenoidal surgery

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  • 1 Department of Cognitive Neuropsychology, Tilburg University; and
  • 2 Departments of Neurosurgery and
  • 3 Internal Medicine, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
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OBJECTIVE

Patients with nonfunctioning pituitary adenomas (NFPAs) can suffer from cognitive dysfunction. However, the literature on longitudinal cognitive follow-up of patients undergoing endoscopic endonasal transsphenoidal surgery (EETS) is limited. This study was performed to investigate perioperative cognitive status and course in patients with NFPAs.

METHODS

Patients underwent computerized neuropsychological assessment 1 day before (n = 45) and 3 months after (n = 36) EETS. Performance in 7 domains was measured with a computerized test battery (CNS Vital Signs) and standardized using data from a healthy control group. The authors conducted analyses of cognitive performance at both time points and changes pre- to post-ETSS on a group and an individual level. Linear multiple regression analyses were employed to investigate predictors of cognitive performance.

RESULTS

On average, patients scored significantly lower in 6 of 7 cognitive domains before and after surgery than controls. Impairment proportions were significantly higher among patients (56% before surgery, 63% after surgery) than among controls. Patients showed no change over time in group-level (mean) performance, but 28% of individual patients exhibited cognitive improvement and 28% exhibited cognitive decline after surgery. Hormonal deficiency showed a positive correlation with verbal memory before surgery. Postoperative performances in all cognitive domains were predicted by preoperative performances.

CONCLUSIONS

Cognitive impairment was present before and after EETS in over half of NFPA patients. Individual patients showed diverse postoperative cognitive courses. Monitoring of cognitive functioning in clinical trajectories and further identification of disease-related and psychological predictors of cognition are warranted.

ABBREVIATIONS EETS = endoscopic endonasal transsphenoidal surgery; HADS = Hospital Anxiety and Depression Scale; NFPA = nonfunctioning pituitary adenoma; RCI = reliable change index.

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Contributor Notes

Correspondence Elke Butterbrod: Tilburg University, Tilburg, The Netherlands. e.butterbrod@tilburguniversity.edu..

INCLUDE WHEN CITING Published online August 23, 2019; DOI: 10.3171/2019.5.JNS19595.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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