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Transsphenoidal hypophysectomy

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https://www.readbyqxmd.com/read/27900232/vanishing-pituitary-macroadenoma-a-case-report
#1
Emily P Sieg, Hayk Stepanyan, Russell Payne, Tao Ouyang, Brad E Zacharia
Pituitary macroadenomas are the most common suprasellar lesions in adults and are typically managed surgically through transsphenoidal resection when symptomatic. Due to their close proximity to the optic chiasm, pituitary macroadenomas often present with signs of bitemporal hemianopsia. Alternatively, these tumors can cause mass effect, thus presenting with signs of elevated intracranial pressure or can present with signs and symptoms of endocrine dysfunction. Here, we discuss a 55-year-old male diagnosed with a non-functioning pituitary macroadenoma (NFPA) based on cranial imaging, ophthalmologic exam, and endocrine evaluation...
October 20, 2016: Curēus
https://www.readbyqxmd.com/read/27763976/transseptal-subperichondrial-endoscopic-hypophysectomy-with-preservation-of-vital-nasal-structures
#2
Hasmet Yazici, Sedat Doğan, Mehmet Akif Sönmez, Olcay Eser
INTRODUCTION: Pituitary surgery involving different techniques is often applied to the excision of benign adenomas. Operative interventions involved various approaches and techniques. Endoscopic transsphenoidal approach is the less traumatic route to the sella turcica, avoiding brain retraction, and also permitting good visualization, with lower rates of morbidity and mortality. Although mortality of pituitary surgery decreased by advances in surgical techniques morbidities such as synechiae formation, anosmia, bleeding, nasal septal perforations, drying, and incrustation due to traumatization of the nasal structures such as septum, nasal mucosa, and middle concha are the current problems in pituitary surgery...
October 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/27509071/surgical-management-of-carney-complex-associated-pituitary-pathology
#3
Russell R Lonser, Gautam U Mehta, Bogdan A Kindzelski, Abhik Ray-Chaudhury, Alexander O Vortmeyer, Robert Dickerman, Edward H Oldfield
BACKGROUND: Carney complex (CNC) is a familial neoplasia syndrome that is associated with pituitary-associated hypersecretion of growth hormone (GH) (acromegaly). The underlying cause of pituitary GH hypersecretion and its management have been incompletely defined. OBJECTIVE: To provide biological insight into CNC-associated pituitary pathology and improve management, we analyzed findings in CNC patients who underwent transsphenoidal surgery. METHODS: Consecutive CNC patients at the National Institutes of Health with acromegaly and imaging evidence of a pituitary adenoma(s) who underwent transsphenoidal resection of tumor(s) were included...
August 9, 2016: Neurosurgery
https://www.readbyqxmd.com/read/27473973/dynamic-computed-tomography-of-the-pituitary-gland-using-a-single-slice-scanner-in-dogs-with-pituitary-dependent-hypercortisolism
#4
Sara Del Magno, Guy C M Grinwis, George Voorhout, Björn P Meij
Selective removal of the pituitary adenoma has not been advocated in dogs with pituitary-dependent hypercortisolism because the pituitary adenoma is usually not visualized on routine computed tomography (CT). Dynamic pituitary CT scanning is aimed at the detection of the pituitary flush and, indirectly, at the presence and position of the adenoma. The first aim of this retrospective study was to compare findings of a multiple slice dynamic scanning protocol with those of a single slice dynamic protocol using a single slice CT scanner...
August 2016: Research in Veterinary Science
https://www.readbyqxmd.com/read/27425149/the-influence-of-pituitary-size-on-outcome-after-transsphenoidal-hypophysectomy-in-a-large-cohort-of-dogs-with-pituitary-dependent-hypercortisolism
#5
S J van Rijn, S Galac, M A Tryfonidou, J W Hesselink, L C Penning, H S Kooistra, B P Meij
BACKGROUND: Transsphenoidal hypophysectomy is one of the treatment strategies in the comprehensive management of dogs with pituitary-dependent hypercortisolism (PDH). OBJECTIVES: To describe the influence of pituitary size at time of pituitary gland surgery on long-term outcome. ANIMALS: Three-hundred-and-six dogs with PDH. METHODS: Survival and disease-free fractions were analyzed and related to pituitary size; dogs with and without recurrence were compared...
July 2016: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/27244208/cerebral-vasospasm-following-transsphenoidal-hypophysectomy-in-the-treatment-of-lymphocytic-hypophysitis
#6
Kaveh Karimnejad, Justin Michael Sweeney, Jastin Levi Antisdel
Cerebral vasospasm following transsphenoidal hypophysectomy is an exceedingly rare but serious complication with high morbidity and mortality. The initial signs and symptoms of cerebral vasospasm following transsphenoidal hypophysectomy are changes in mental status, motor deficits, and speech difficulties. Symptomatic vasospasm is difficult to reverse despite treatment and often only resolves with time. Furthermore, most transsphenoidal hypophysectomy patients have been discharged before the onset of vasospasm, so when they do present it is often in a fulminant form and recalcitrant to available treatments...
June 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/26998652/the-pathophysiology-of-early-hypotension-following-epinephrine-containing-local-anesthetic-infiltration-of-the-nasal-mucosa-in-patients-undergoing-endoscopic-transsphenoidal-hypophysectomy-a-prospective-observational-study
#7
Matthew D Wiles, Matthew I Sanders, Saurabh Sinha, Showkat Mirza, John C Andrzejowski
In patients undergoing endoscopic transsphenoidal hypophysectomy, the nasal mucosa is often infiltrated with local anesthetic solutions that contain epinephrine to aid hemostasis. This may, however, result in hemodynamic changes, especially hypotension. We characterized the cardiovascular changes using a LiDCOrapid monitor in 13 patients after the infiltration of 4% articaine containing 1:200,000 epinephrine. Nine (69%) had a >20% decrease in mean arterial pressure at a median time of 116 seconds after the infiltration of articaine with epinephrine...
March 18, 2016: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/26455764/evaluation-of-fine-feeding-system-and-angioarchitecture-of-giant-pituitary-adenoma-implications-for-establishment-of-surgical-strategy
#8
Yoshikazu Ogawa, Kenichi Sato, Yasushi Matsumoto, Teiji Tominaga
BACKGROUND: Giant pituitary adenomas carry higher surgical risks despite recent advances in microsurgical and/or endoscopic surgery, and postoperative acute catastrophic changes without major vessel disturbance are still extremely difficult to predict, may manifest as postoperative pituitary apoplexy, and are associated with poor outcomes. METHODS: Eight males and 4 females aged 31-72 years (mean 50.7 years) with giant pituitary adenomas underwent preoperative investigation of fine angioarchitecture using C-arm cone-beam computed tomography with a flat-panel detector...
January 2016: World Neurosurgery
https://www.readbyqxmd.com/read/26215205/radiological-study-of-the-anatomy-of-the-keystone-area-of-the-nasal-septum-using-computed-tomography-to-aid-septal-surgery
#9
S Carr, V Twigg, S Mirza
OBJECTIVES: An optimum septoplasty result may require complete detachment of the superior osseocartilaginous junction (OCJ), but this may lead to disruption of the keystone area with loss of nasal support and consequent supratip depression deformity. The aim of this study was to analyse normal keystone anatomy using CT scan images and to estimate the incidence of risk of supratip depression when completely detaching the OCJ. DESIGN: Retrospective study. SETTING: Tertiary referral centre...
August 2016: Clinical Otolaryngology
https://www.readbyqxmd.com/read/26146047/-the-effectiveness-of-using-hyperhaes-hypertonic-isooncotic-plasma-solution-to-achieve-stable-intracranial-hypotension-in-endoscopic-endonasal-transsphenoidal-adenomectomy-as-an-alternative-to-the-invasive-external-lumbar-drainage
#10
M A Kutin, A B Kurnosov, P L Kalinin, D V Fomichev, S N Alekseev, A N Shkarubo, O I Sharipov, Yu V Strunina
The structure of surgery of pituitary adenomas has been fundamentally changed over the past decade. The transnasal transsphenoidal approach is currently used to resect more than 95% of adenomas. The wide use of endoscopy has changed the need for perioperative control of intracranial pressure. While controlled intracranial hypertension was previously used during microscopically controlled transnasal surgery to bring the suprasellar capsule and tumor remnants to the field of vision, endoscopically controlled tumor resection implies that controlled intracranial hypotension is required to achieve complete spreading of the suprasellar capsule...
2015: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
https://www.readbyqxmd.com/read/26115709/impact-of-selective-pituitary-gland-incision-or-resection-on-hormonal-function-after-adenoma-or-cyst-resection
#11
Garni Barkhoudarian, Aaron R Cutler, Sam Yost, Bjorn Lobo, Amalia Eisenberg, Daniel F Kelly
OBJECTIVE: With the resection of pituitary lesions, the anterior pituitary gland often obstructs transsphenoidal access to the lesion. In such cases, a gland incision and/or partial gland resection may be required to obtain adequate exposure. We investigate this technique and determine the associated risk of post-operative hypopituitarism. METHODS: All patients who underwent surgical resection of a pituitary adenoma or Rathke cleft cyst (RCC) between July 2007 and January 2013 were analyzed for pre- and post-operative hormone function...
December 2015: Pituitary
https://www.readbyqxmd.com/read/25959680/the-prognostic-value-of-perioperative-profiles-of-acth-and-cortisol-for-recurrence-after-transsphenoidal-hypophysectomy-in-dogs-with-corticotroph-adenomas
#12
S J van Rijn, J M Hanson, D Zierikzee, H S Kooistra, L C Penning, M A Tryfonidou, B P Meij
BACKGROUND: Transsphenoidal hypophysectomy is an effective treatment for dogs with pituitary-dependent hypercortisolism (PDH). However, long-term recurrence of hypercortisolism is a well-recognized problem, indicating the need for reliable prognostic indicators. OBJECTIVES: The aim of this study was to evaluate the prognostic value of perioperative plasma ACTH and cortisol concentrations for identifying recurrence of hypercortisolism after transsphenoidal hypophysectomy...
May 2015: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/25894081/cesare-cavina-1888-1935-a-father-of-transsphenoidal-surgery
#13
Giorgio Frank, Matteo Zoli, Diego Mazzatenta, Ernesto Pasquini, Giovanni Farneti
Among the fathers of transsphenoidal surgery, a relevant role should be reserved for Cesare Cavina (1888-1935). He had the merit to develop and popularize in Italy this approach for pituitary tumors, performing 47 transsphenoidal hypophysectomies out of his personal series of 66 patients between 1927 and 1935. He contributed to this surgery by introducing radiological control of the surgical trajectory to reduce the risk of complications and increase the safety of this approach. We think that both his short lifespan (he died when he was 47 years old) and the language of his papers (Italian and not English) are two important factors that have contributed to forgetting his role in the history of transsphenoidal surgery...
June 2015: Acta Neurochirurgica
https://www.readbyqxmd.com/read/25731796/sellar-floor-reconstruction-with-the-medpor-implant-versus-autologous-bone-after-transnasal-transsphenoidal-surgery-outcome-in-200-consecutive-patients
#14
COMPARATIVE STUDY
Brandon D Liebelt, Meng Huang, David S Baskin
OBJECTIVE: The Medpor porous polyethylene implant provides benefits to perform sellar floor reconstruction when indicated. This material has been used for cranioplasty and reconstruction of skull base defects and facial fractures. We present the most extensive use of this implant for sellar floor reconstruction and document the safety and benefits provided by this unique implant. METHODS: The medical charts for 200 consecutive patients undergoing endonasal transsphenoidal surgery from April 2008 through December 2011 were reviewed...
August 2015: World Neurosurgery
https://www.readbyqxmd.com/read/25724315/surgical-management-of-cushing-s-disease
#15
REVIEW
Robert F Dallapiazza, Edward H Oldfield, John A Jane
BACKGROUND: Transsphenoidal selective adenomectomy is the first-line treatment for Cushing's disease. At experienced centers, early remission rates after transsphenoidal surgery range from 65 to 98%, however disease relapse frequently occurs with rates ranging from 2 to 35% at long-term follow up. METHODS: This article discusses recently reported studies on the surgical outcomes from transsphenoidal surgery for Cushing's disease. CONCLUSIONS: One of the keys to a successful long-term surgical outcome is meticulous dissection using the adenoma's pseudocapsule as a surgical plane for complete resection...
April 2015: Pituitary
https://www.readbyqxmd.com/read/25583436/current-trends-in-surgical-approach-and-outcomes-following-pituitary-tumor-resection
#16
COMPARATIVE STUDY
Jennifer A Villwock, Mark R Villwock, Parul Goyal, Eric M Deshaies
OBJECTIVES/HYPOTHESIS: The goals of pituitary tumor resection include normalizing endocrine function, relieving mass effect, and minimizing risk of recurrence. This study investigated current trends in costs and complications for transfrontal and transsphenoidal pituitary surgery. STUDY DESIGN: Retrospective review of the 2008-2011 Nationwide Inpatient Sample for patients undergoing pituitary lesion resection. METHODS: Demographics and outcomes were compared between transfrontal and transsphenoidal surgical approaches using χ(2) tests...
June 2015: Laryngoscope
https://www.readbyqxmd.com/read/25547751/-sphenoid-sinus-agenesis
#17
Serdar Baylançiçek, Mehmet Erdem Yıldız, Mehmet Emre Üstündağ
Agenesis of paranasal sinuses is an uncommon finding mainly seen in the frontal and maxillary sinuses. Agenesis of sphenoid sinuses is an extremely rare condition. In this article, we present an 18-year-old female patient suffering from headache and nasal obstruction without any skeletal or cranial anomalies. Axial, coronal and sagittal computed tomography revealed absent sphenoid sinuses. Surgeons should be aware of sphenoid sinus agenesis, when transsphenoidal hypophysectomy and endoscopic sinus surgery are scheduled, in particular...
November 2014: Kulak Burun Boğaz Ihtisas Dergisi: KBB, Journal of Ear, Nose, and Throat
https://www.readbyqxmd.com/read/25346922/long-term-follow-up-on-cushing-disease-patient-after-transsphenoidal-surgery
#18
Insook Jeong, Moonyeon Oh, Ja Hye Kim, Ja Hyang Cho, Jin-Ho Choi, Han-Wook Yoo
Cushing disease is caused by excessive adrenocorticotropic hormone (ACTH) production by the pituitary adenoma. Transsphenoidal surgery is its first-line treatment. The incidence of Cushing disease in children and adolescents is so rare that long-term prognoses have yet to be made in most cases. We followed-up on a 16-year-old male Cushing disease patient who presented with rapid weight gain and growth retardation. The laboratory findings showed increased 24-hour urine free cortisol and lack of overnight cortisol suppression by low-dose dexamethasone test...
September 2014: Annals of Pediatric Endocrinology & Metabolism
https://www.readbyqxmd.com/read/25105828/determination-of-ec95-of-remifentanil-for-smooth-emergence-from-propofol-anesthesia-in-patients-undergoing-transsphenoidal-surgery
#19
Seung Ho Choi, Kyeong Tae Min, Jeong-Rim Lee, Kwan Woong Choi, Kyung-Hwa Han, Eui Hyun Kim, Hye Jin Oh, Jae Hoon Lee
BACKGROUND: In patients undergoing pituitary surgery using a transsphenoidal approach, anesthesia emergence should be smooth with minimal coughing. Recent studies demonstrated that a target-controlled infusion of remifentanil effectively suppresses coughing induced by the endotracheal tube. We investigated the EC95 of remifentanil for smooth emergence without coughing from propofol anesthesia in patients undergoing transsphenoidal hypophysectomy. MATERIALS AND METHODS: A total of 41 patients undergoing transsphenoidal hypophysectomy, aged 20 to 65 years, with an ASA physical status of I or II, were enrolled...
April 2015: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/25032116/endoscopic-endonasal-transsphenoidal-hypophysectomy-two-hand-versus-four-hand-technique-our-experience
#20
Satya Prakash Dubey, Vishal Rattan Munjal
An endoscope was used in transsphenoidal surgery and eventually replaced the operating microscope as a tool for visualization. Initially patients underwent operation via a sublabial transseptal approach using a rigid endoscope in conjunction with an operating microscope. The subsequent operations were performed through a nostril using only rigid endoscopes, initially through single nostril by one surgeon (two hands) and later through both nostrils by two surgeons (four surgeons). This is a retrospective study of 96 patients who had pituitary adenomas in last ten years...
September 2014: Indian Journal of Otolaryngology and Head and Neck Surgery
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