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Endoscopic pituitary surgery

Nathan T Zwagerman, Georgios Zenonos, Stefan Lieber, Wei-Hsin Wang, Eric W Wang, Juan C Fernandez-Miranda, Carl H Snyderman, Paul A Gardner
The endoscopic endonasal approach (EEA) has significantly evolved since its initial uses in pituitary and sinonasal surgery. The literature is filled with reports and case series demonstrating efficacy and advantages for the entire ventral skull base. With competence in 'minimally invasive' parasellar approaches, larger and more complex approaches were developed to utilize the endonasal corridor to create maximally invasive endoscopic skull base procedures. The challenges of these more complex endoscopic procedures include a long learning curve and navigating in a narrow corridor; reconstruction of defects presented new challenges and early experience revealed a significantly higher risk of cerebrospinal fluid leak...
October 20, 2016: Journal of Neuro-oncology
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
Huang Guo-Dong, Ji Tao, Yang Ji-Hu, Zheng Wen-Jian, Zhang Xie-Jun, Guo Jian, Li Zhen, Jiang Tai-Peng, Ding Jian-Jun, Gao Yong-Zhong, Liu Wenlan, Li Wei-Ping
BACKGROUND: To compare the clinical outcomes and complications of 247 pituitary tumor patients managed by endoscopic and microscopic approaches in our hospital. METHODS: The authors performed a retrospective review of 100 pituitary tumor patients treated by endoscopic endonasal transsphenoidal surgery (ETS) and 147 patients treated by microscopic transsphenoidal surgery (MTS) at our center from January 2007 to July 2014. The tumors were stratified by Knosp classification and modified Hardy classification, and tumor gross total resection (GTR)/remission rate, visual improvement rate, complications, operation time, intraoperative bleeding and length of hospital stay were compared between ETS and MTS...
October 2016: Journal of Craniofacial Surgery
Chikezie I Eseonu, Karim ReFaey, Jordina Rincon-Torroella, Oscar Garcia, Gary S Wand, Roberto Salvatori, Alfredo Quinones-Hinojosa
OBJECTIVE: The transition from microscopic to a fully endoscopic transsphenoidal surgery requires a surgeon to assess how the change in technique will affect the extent of tumor resection (EOR), outcomes, and complications. We compared a single surgeon's experience transitioning from one technique to the other, and examined the operative outcomes and EOR between microscopic versus endoscopic transsphenoidal surgery. METHODS: Retrospective data analysis of adult patients who were treated surgically for a pituitary adenoma between August 2005 and May 2015 by a single neurosurgeon, who was originally trained and practiced in the microscopic transsphenoidal approach...
October 11, 2016: World Neurosurgery
Bon-Jour Lin, Tzu-Tsao Chung, Meng-Chi Lin, Chin Lin, Dueng-Yuan Hueng, Yuan-Hao Chen, Chung-Ching Hsia, Da-Tong Ju, Hsin-I Ma, Ming-Ying Liu, Chi-Tun Tang
Cavernous segment internal carotid artery (CSICA) injury during endoscopic transsphenoidal surgery for pituitary tumor is rare but fatal. The aim of this study is to investigate anatomical relationship between pituitary macroadenoma and corresponding CSICA using quantitative means with a sense to improve safety of surgery.In this retrospective study, a total of 98 patients with nonfunctioning pituitary macroadenomas undergoing endoscopic transsphenoidal surgeries were enrolled from 2005 to 2014. Intercarotid distances between bilateral CSICAs were measured in the 4 coronal levels, namely optic strut, convexity of carotid prominence, median sella turcica, and dorsum sellae...
October 2016: Medicine (Baltimore)
Amparo Wolf, Alexandra Coros, Joel Bierer, Sandy Goncalves, Paul Cooper, Stan Van Uum, Donald H Lee, Alain Proulx, David Nicolle, J Alexander Fraser, Brian W Rotenberg, Neil Duggal
OBJECTIVE Endoscopic resection of pituitary adenomas has been reported to improve vision function in up to 80%-90% of patients with visual impairment due to these adenomas. It is unclear how these reported rates translate into improvement in visual outcomes and general health as perceived by the patients. The authors evaluated self-assessed health-related quality of life (HR-QOL) and vision-related QOL (VR-QOL) in patients before and after endoscopic resection of pituitary adenomas. METHODS The authors prospectively collected data from 50 patients who underwent endoscopic resection of pituitary adenomas...
October 7, 2016: Journal of Neurosurgery
V Gellner, W Koele, A Wolf, C Gerstenberger, M Mokry, H Stammberger, P V Tomazic
No abstract text is available yet for this article.
October 3, 2016: Clinical Otolaryngology
Stefan Linsler, Sebastian Antes, Sebastian Senger, Joachim Oertel
OBJECTIVE: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood. MATERIALS AND METHODS: We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated...
October 2016: Journal of Neurosciences in Rural Practice
Sercan Gode, Huseyin Biceroglu, Goksel Turhal, Umut Erdogan, Murat S Ates, Isa Kaya, Erkin Ozgiray, Rasit Midilli, Bulent Karci
Endoscopic endonasal approach has been successfully used for the management of pituitary tumors; however, the loss of septal mucosa especially around sphenoethmoidal recess and posterior nasal septum might be a disadvantage of this technique. The aim of this study is to describe a variation of the endonasal approach, "double nasoseptal flap" technique in endoscopic transsphenoidal pituitary surgery, and to evaluate its outcomes. The technique depends on fully harvested bigger nasoseptal flap on one side and smaller on the other...
September 28, 2016: European Archives of Oto-rhino-laryngology
Ji Hwan Jang, Kyu Hong Kim, Young Min Lee, Joon Soo Kim, Young Zoon Kim
BACKGROUND: The aim of this study is to report the results of pure endoscopic endonasal transsphenoidal surgeries (EETSS) for pituitary adenomas (PAs) and to evaluate the efficacy and safety of this procedure. Additionally, we tried to determine the predicting factors for progression of PAs. METHODS: We reviewed the medical records of 331 consecutive patients who underwent pure EETSS of newly diagnosed PAs between April 1998 and December 2014. Demographic, endocrinological, and radiological features and their outcomes, complications, and hospital stay durations were retrospectively assessed in these patients...
September 20, 2016: World Neurosurgery
Hasan A Zaidi, David J Cote, William T Burke, Joseph P Castlen, Wenya Linda Bi, Edward R Laws, Ian F Dunn
INTRODUCTION: Pituitary tumor apoplexy can result from either hemorrhagic or infarctive expansion of pituitary adenomas, and related mass effect can result in compression of critical neurovascular structures. The time course of recovery of visual field deficits, headaches, ophthalmoparesis, and pituitary dysfunction after endoscopic transsphenoidal surgery has not been well established. METHODS: Medical records were retrospectively reviewed for all patients who underwent endoscopic transsphenoidal surgery for pituitary tumor apoplexy from April 2008 to November 2014...
September 20, 2016: World Neurosurgery
John S Kuo, Garni Barkhoudarian, Christopher J Farrell, Mary E Bodach, Luis M Tumialan, Nelson M Oyesiku, Zachary Litvack, Gabriel Zada, Chirag G Patil, Manish K Aghi
BACKGROUND: Numerous technological adjuncts are used during transsphenoidal surgery for nonfunctioning pituitary adenomas (NFPAs), including endoscopy, neuronavigation, intraoperative magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) diversion, and dural closure techniques. OBJECTIVE: To generate evidence-based guidelines for the use of NFPA surgical techniques and technologies. METHODS: An extensive literature search spanning January 1, 1966, to October 1, 2014, was performed, and only articles pertaining to technological adjuncts for NFPA resection were included...
October 2016: Neurosurgery
Jinsen Zhang, Shugang Xu, Qinglin Liu, Xueen Li, Deze Jia, Gang Li
BACKGROUND: Intracranial schwannomas usually arise from sensory nerves with a predilection for the trigeminal nerve and the vestibular component of the eighth cranial nerve (VIII). Schwannoma arising in the sella and extending into the suprasellar region is exceedingly rare and easily misdiagnosed as pituitary macroadenoma. Only 26 cases of intrasellar schwannomas have been reported in the literature. CASE DESCRIPTION: A patient with an intrasellar schwannoma and suprasellar extension was presurgically diagnosed as having pituitary macroadenoma...
September 6, 2016: World Neurosurgery
Yuta Murakami, Taku Sato, Shinya Jinguji, Yugo Kishida, Tadashi Watanabe, Osamu Suzuki, Kazuhiko Ikeda, Miyuki Homma, Sanae Midorikawa, Kiyoshi Saito
We report a rare case of primary pituitary lymphoma in a 75-year-old immunocompetent woman. The patient was blind in the right eye and presented with visual disturbance in the left eye that started 2 months previously. She also exhibited right third and fifth cranial nerve palsy. Magnetic resonance imaging(MRI)revealed an intrasellar mass lesion with right cavernous sinus invasion and suprasellar extension with compression of the optic chiasm. The mass lesion was isointense on both T1WI and T2WI, and showed less enhancement than a normal pituitary gland on gadolinium-enhanced T1WI...
September 2016: No Shinkei Geka. Neurological Surgery
Rodrigo V S Bastos, Carla Maria D M Silva, Jose Vicente Tagliarini, Marco Antonio Zanini, Flavio R Romero, Cesar Luiz Boguszewski, Vania Dos Santos Nunes
We conducted a systematic review and meta-analysis of randomized and non-randomized controlled trials that compared pure endoscopic with microscopic transsphenoidal surgery (TSS) in the resection of pituitary tumors. Embase, PubMed, Lilacs, and Central Cochrane were used as our data sources. The outcomes were total tumor resection, achievement of biochemical control of functioning adenomas, hospital stay and surgery complications. The randomized trials were analyzed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach...
September 5, 2016: Archives of Endocrinology and Metabolism
Fatih Kuzu, Mustafa Unal, Sanser Gul, Taner Bayraktaroglu
Pituitary apoplexy is a medical condition that needs urgent diagnosis and treatment. It may occur spontaneously or may be precipitated by a variety of reasons including dynamic endocrine tests. Although pituitary apoplexy is usually seen in non-functional pituitary adenoma, it can also be seen in ACTH secreting macroadenomas. ACTH secreting adenomas present usually as microadenomas and in these patients apoplexy is rarely seen. In this paper we present a 30 years old male patient with a history of Cushing's disease who suffered from pituitary apoplexy after1 mg dexamethasone suppression test...
February 5, 2016: Turkish Neurosurgery
Daniel Rotariu, Alexandru Budu, Ziyad Faiyad, Ion Poeata
AIM: Evaluate the role and accuracy of the virtual endoscopy realized using commercially available software, OsiriX, as a method of planning of surgical interventions. MATERIAL AND METHODS: The CTs of 22 patients with pituitary adenomas proposed for endoscopic approach were reconstructed using OsiriX. VE was performed prior surgery to assess the surgical corridor and particular anatomy. We have evaluated the following landmarks: inferior and middle turbinate, sphenoid ostia (SO), choanal arch (Ch), sphenoethmoidal recess (SER), sphenoid septa, sella turcica, carotid prominences and opticocarotid recesses (OCR)...
January 25, 2016: Turkish Neurosurgery
Sivashanmugam Dhandapani, Harminder Singh, Hazem M Negm, Salomon Cohen, Vijay K Anand, Theodore H Schwartz
BACKGROUND: Despite the substantial impact of cavernous sinus invasion(CSI) in pituitary adenoma surgery, its radiological determination has been inconsistent and variable, with unclear role of endonasal endoscopic surgery. This is a systematic review and pooled data meta-analysis of literature to ascertain the best radiological criteria for CSI, and verify the efficacy and safety of endonasal endoscopic approach. METHODS: We searched MEDLINE database(1993-2015) to identify studies on radiological criteria for CSI, and endonasal surgery...
August 30, 2016: World Neurosurgery
Samuel J C Fishpool, Anthony Amato-Watkins, Caroline Hayhurst
The objective is to assess whether free middle turbinate (FMT) graft reconstruction, after endoscopic endonasal pituitary surgery, combines an acceptably low post-operative cerebrospinal fluid (CSF) leak rate with acceptable rhinological morbidity. This study identified 50 patients who underwent endoscopic endonasal pituitary surgery by the senior author in our teaching hospital between May 2011 and June 2012. FMT graft reconstruction was used in 32 cases. 18 patients were judged pre-operatively as not suitable for FMT reconstruction according to a novel skull base reconstructive algorithm...
September 1, 2016: European Archives of Oto-rhino-laryngology
Olympia Koulouri, Narayanan Kandasamy, Andrew C Hoole, Daniel Gillett, Sarah Heard, Andrew S Powlson, Dominic G O'Donovan, Anand K Annamalai, Helen L Simpson, Scott A Akker, Simon J B Aylwin, Antonia Brooke, Harit Buch, Miles J Levy, Niamh Martin, Damian Morris, Craig Parkinson, James R Tysome, Tom Santarius, Neil Donnelly, John Buscombe, Istvan Boros, Rob Smith, Franklin Aigbirhio, Nagui M Antoun, Neil G Burnet, Heok Cheow, Richard J Mannion, John D Pickard, Mark Gurnell
OBJECTIVE: To determine if functional imaging using (11)C-methionine positron emission tomography co-registered with 3D gradient echo MRI (Met-PET/MRI), can identify sites of residual active tumour in treated acromegaly, and discriminate these from post-treatment change, to allow further targeted treatment. DESIGN/METHODS: Twenty-six patients with persistent acromegaly after previous treatment, in whom MRI appearances were considered indeterminate, were referred to our centre for further evaluation over a 4...
November 2016: European Journal of Endocrinology
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