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Microscopic pituitary surgery

Bassel Zebian, Francesco Vergani, José Pedro Lavrador, Soumya Mukherjee, William John Kitchen, Vita Stagno, Christos Chamilos, Benedetta Pettorini, Conor Mallucci
X-rays and ventriculograms were the first imaging modalities used to localize intracranial lesions including brain tumors as far back as the 1880s. Subsequent advances in preoperative radiological localization included computed tomography (CT; 1971) and MRI (1977). Since then, other imaging modalities have been developed for clinical application although none as pivotal as CT and MRI. Intraoperative technological advances include the microscope, which has allowed precise surgery under magnification and improved lighting, and the endoscope, which has improved the treatment of hydrocephalus and allowed biopsy and complete resection of intraventricular, pituitary and pineal region tumors through a minimally invasive approach...
December 21, 2016: CNS Oncology
Vivek Tandon, Amol Raheja, Ashish Suri, P Sarat Chandra, Shashank S Kale, Rajinder Kumar, Ajay Garg, Mani Kalaivani, Ravindra M Pandey, Bhawani S Sharma
Till date there are no randomized trials to suggest the superiority of intra-operative magnetic resonance imaging (IOMRI) guided trans-sphenoidal pituitary resection over two dimensional fluoroscopic (2D-F) guided resections. We conducted this trial to establish the superiority of IOMRI in pituitary surgery. Primary objective was to compare extent of tumor resection between the two study arms. It was a prospective, randomized, outcome assessor and statistician blinded, two arm (A: IOMRI, n=25 and B: 2D-F, n=25), parallel group clinical trial...
November 18, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Eduardo de Arnaldo S Vellutini
No abstract text is available yet for this article.
October 2016: Archives of Endocrinology and Metabolism
Hazem M Negm, Rafid Al-Mahfoudh, Manish Pai, Harminder Singh, Salomon Cohen, Sivashanmugam Dhandapani, Vijay K Anand, Theodore H Schwartz
OBJECTIVE Regrowth of the lesion after surgical removal of pituitary adenomas is uncommon unless subtotal resection was originally achieved in the first surgery. Treatment for recurrent tumor can involve surgery or radiotherapy. Locations of residual tumor may vary based on the original approach. The authors evaluated the specific sites of residual or recurrent tumor after different transsphenoidal approaches and describe the surgical outcome of endoscopic endonasal transsphenoidal reoperation. METHODS The authors analyzed a prospectively collected database of a consecutive series of patients who had undergone endoscopic endonasal surgeries for residual or recurrent pituitary adenomas after an original transsphenoidal microscopic or endoscopic surgery...
October 28, 2016: Journal of Neurosurgery
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
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 surgery (EETSS) for pituitary adenomas (PAs) and to evaluate the efficacy and safety of this procedure. In addition, 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, endocrinologic, and radiologic features and their outcomes, complications, and hospital stay durations were retrospectively assessed in these patients...
December 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
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...
October 2016: Archives of Endocrinology and Metabolism
Lütfi Postalci, İbrahim Erdim, Bülent Demirgil, Ömür Günaldi, Murad Asiltürk, Hakan Demirci, Hakan Kina, Uzay Erdoğan, Mine Yazici, Erhan Emel
AIM: Major complications from microscopic transnasal hypophyseal surgery (MTHS), such as cerebrospinal fluid rhinorrhea, carotid injury, and optic nerve injury, are very rare. However, late rhinological complications can be ignored because they are a minor cause of morbidity compared with major complications. In this study, we extensively examined postoperative rhinological complications in patients who underwent MTHS for pituitary adenoma. MATERIAL AND METHODS: Thirty-one patients diagnosed with pituitary adenoma, who underwent MTHS and whose preoperative nasal examinations were recorded between January 2007 and January 2014, were included in the study...
October 2, 2015: 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
Jitin Bajaj, Radhe Shyam Mittal, Achal Sharma
BACKGROUND: Pituitary masses are common lesions accounting for about 15-20% of all brain tumours. Oozing blood is an annoyance in microscopic sublabial trans-sphenoidal approach for these masses. There have been many ways of reducing the ooze, having their own pros and cons. OBJECTIVE: To find out the efficacy and safety of clonidine in reducing blood loss in pituitary adenoma surgery through a randomized masked trial. METHODS: It was a prospective randomized controlled trial done...
August 18, 2016: British Journal of Neurosurgery
A Buliman, L G Tataranu, V Ciubotaru, T L Cazac, C Dumitrache
Object. The aim of this study was to analyze a series of 28 patients with acromegaly who underwent a multimodal surgical, medical and radiosurgical therapy, with a special attention to the advantages, complications, and predictive factors of a successful outcome. Methods. 28 consecutive cases of GH-secreting pituitary adenomas, who underwent transsphenoidal endoscopic or microscopic surgery, between 1 January 2014 and 31 December 2014 were retrospectively reviewed. Tumors were classified according to the diameter, measured on MRI, as micro- or macroadenomas, and parasellar (cavernous sinus) tumor extension was analyzed based on the Knosp grading score...
April 2016: Journal of Medicine and Life
Richard A Prayson
Sarcoidosis is a well-recognized systemic granulomatous process which involves the central nervous system in 5-15% of patients. One of the more frequent sites of central nervous system involvement is the pituitary and hypothalamic region. Involvement of the sellar region by sarcoidosis is overall an infrequent occurrence, comprising less than 1% of all intrasellar lesions. Patients typically present with an infiltrative lesion on imaging studies and clinically with symptoms related to diabetes insipidus or hyperprolactinemia...
December 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Wei Lian, Ren Zhi Wang, Bing Xing, Yong Yao
The aim of the study was to examine the curative effects and proper radiotherapy plan of head γ-stereotactic radiotherapy (γ-SRT) for the treatment of functional pituitary macroadenoma. Clinical samples of 30 patients that underwent γ-SRT (radiotherapy group) and 26 patients that underwent pituitary adenoma resection via single nasal-sphenoidal approach (surgery group) were analyzed retrospectively and their curative effects were compared. The results showed that in the radiotherapy group, 12 cases accepted single fraction irradiation, with an average maximum diameter of tumor body of 1...
August 2016: Oncology Letters
Bhawani Shanker Sharma, Dattaraj Paramanand Sawarkar, Ashish Suri
Endoscopic pituitary surgery is useful in all micro- and macro-pituitary adenomas including those with suprasellar and cavernous sinus extension. The endoscope provides a panoramic close-up, a multi-angled view with excellent illumination and magnification, permitting complete excision of the tumor with preservation of normal pituitary. However, surgeons need to learn altogether different skills unique to endoscopy and the learning curve is steep. The learning curve can be shortened by proper selection of cases, gradual transition from the microscopic to the endoscopic approach, adequate sphenoethmoidal recess widening, identification of important landmarks during each stage of surgery, and use of neuronavigation...
July 2016: Neurology India
Talha Qureshi, Fahad Chaus, Louis Fogg, Mona Dasgupta, David Straus, Richard W Byrne
INTRODUCTION: The transsphenoidal endoscopic approach is a relatively new procedure compared to the microscopic approach in pituitary adenoma resection. The endoscopic approach has shown to significantly decrease the rate of complications, time in the operating room and hospital, and patient post-op discomfort. However, this procedure requires the surgeon to make use of different visual and tactile clues that must be developed with experience. Therefore, it is important to understand the learning curve that the surgeon must overcome to become proficient with the endoscopic approach...
December 2016: British Journal of Neurosurgery
Gonul Guvenc, Ceren Kizmazoglu, Ercan Pinar, Abdülkadir Imre, Ismail Kaya, Hamdi Bezircioglu, Nurullah Yuceer
This retrospective study aimed to define outcomes and complications of endoscopic versus microscopic transsphenoidal surgery in pituitary adenoma. Data of 94 patients who underwent transsphenoidal endoscopic (n = 45) or microscopic surgery (n = 49) between June 2000 and June 2014 for pituitary adenoma, performed at Katip Çelebi University Hospital, were retrospectively analyzed. The patients' symptomatology, type of adenoma, radiologic findings, surgical outcomes, and preoperative and postoperative complications were investigated...
June 2016: Journal of Craniofacial Surgery
Sammie Roberts, Manuel Thomas Borges, Kevin O Lillehei, B K Kleinschmidt-DeMasters
PURPOSE: Double pituitary adenomas are defined as two adenomas within a gland. These have distinct light microscopic and immunohistochemical features and may be clearly-separate or contiguous. Most reports have focused on the various hormonal combinations in double tumors rather than on any potential increased risk for residual mass or endocrinopathy. METHODS: Departmental files were searched to identify all double adenomas from 1/1/2000 to 3/1/2016, with review of magnetic resonance imaging (MRI) to determine if the dual nature of the lesions could be discerned retrospectively after histologic diagnosis of double adenoma...
October 2016: Pituitary
Harminder Singh, Walid I Essayed, Aaron Cohen-Gadol, Gabriel Zada, Theodore H Schwartz
Transsphenoidal microscopic pituitary surgery has long been considered the gold standard in surgical treatment of pituitary tumors. Endonasal endoscopic pituitary surgery has come into prominence over the last two decades as an alternative to microscopic surgery. In this review, we use recent literature to discuss the advantages and disadvantages of each approach. Our review shows that for small intrasellar tumors, both approaches appear equally effective in experienced hands. For larger tumors with extrasellar extension, the endoscopic approach offers several advantages and may improve outcomes associated with the extent of resection and postoperative complications...
May 9, 2016: Journal of Neuro-oncology
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