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Transsphenoidal Surgery

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https://www.readbyqxmd.com/read/28445162/binostril-endoscopic-transsphenoidal-neurosurgery-for-pituitary-adenomas-experience-with-42-patients
#1
Guan Sun, Ying Cao, Nan Jiang, Dekang Nie, Zhengqiang Wan, Min Li, Chiyuan Ma, Jun Guo
Here we review the technical aspects of our experience with the neuroendoscopic bilateral nostril (binostril) transsphenoidal approach for pituitary adenomas. A total of 42 patients were treated in our hospital from September 2013 to December 2015. Total tumor resection was completed in 31 cases, nearly full resection was achieved in 9 cases, and partial resection was achieved in 2 cases. In most cases clinical symptoms were relieved after surgery. These included 18/22 cases with visual field and vision disorders; 19/25 cases with headaches; 11/15 cases where high baseline PRL returned to normal levels; 6/7 cases where elevated blood GH returned to normal levels; and 2/3 cases where elevated blood ACTH returned to normal levels after surgery...
April 9, 2017: Oncotarget
https://www.readbyqxmd.com/read/28437813/presenting-symptoms-of-pituitary-apoplexy
#2
Efstratios-Stylianos Pyrgelis, Ioannis Mavridis, Maria Meliou
The classical term "pituitary apoplexy" (PA) describes a clinical syndrome usually characterized by abrupt onset of headache accompanied by neurologic and/or endocrinologic deterioration due to sudden expansion of a mass within the sella turcica as a result of hemorrhage or infarction within a pituitary tumor and adjacent pituitary gland. PA is a medical emergency and a difficult diagnosis to establish. Thus this article reviews the presenting symptoms of PA patients to help clinicians recognize or at least suspect this critical condition early on...
April 24, 2017: Journal of Neurological Surgery. Part A, Central European Neurosurgery
https://www.readbyqxmd.com/read/28434959/analysis-of-137-patients-who-underwent-endoscopic-transsphenoidal-pituitary-adenoma-resection-under-high-field-intraoperative-magnetic-resonance-imaging-navigation
#3
Huaping Zhang, Fuyu Wang, Tao Zhou, Peng Wang, Xiaolei Chen, Jiashu Zahng, Dingbiao Zhou
OBJECTIVE: Endonasal resection of the pituitary embodies the minimally invasive concept. Pure endoscopic resection of pituitary adenoma has become the most popular surgical approach. Intraoperative magnetic resonance imaging (iMRI) systems have been in use for endoscopic resection of pituitary adenomas. The study aimed to evaluate the effectiveness of iMRI and neuroimaging navigation techniques during endoscopic endonasal transsphenoidal surgery of pituitary adenomas. METHODS: Data from 137 patients who underwent resection of endoscopic pituitary adenoma under 1...
April 18, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28423663/a-novel-total-pituitary-hormone-index-as-an-indicator-of-postoperative-pituitary-function-in-patients-undergoing-resection-of-pituitary-adenomas
#4
Shousen Wang, Biao Li, Chenyu Ding, Deyong Xiao, Liangfeng Wei
The purpose of this study was to investigate the differences between pre- and postoperative pituitary hormone levels in patients undergoing surgical resection of pituitary adenoma and to identify factors associated with preoperative hypopituitarism.Data from 81 patients with histologically confirmed functioning and non-functioning pituitary adenomas (NFPA) who underwent transsphenoidal resection from January 2011 to December 2013 were retrospectively analyzed. Logistic regression was applied to analyze factors associated with preoperative hypopituitarism...
March 7, 2017: Oncotarget
https://www.readbyqxmd.com/read/28421822/deflation-of-a-rathke-cleft-cyst-triggered-rupture-of-a-superior-hypophyseal-artery-aneurysm-a-case-report
#5
Ryuheki Kitai, Takahiro Yamauchi, Yoshikazu Arai, Tetsuya Hosoda, Norichika Hashimoto, Kenzo Tsunetoshi, Yoshifumi Higashino, Ken-Ichiro Kikuta
A 57-year-old woman was diagnosed as a Rathke cleft cyst (RCC). Endoscopic transsphenoidal surgery (TSS) was performed uneventfully. She developed subarachnoid haemorrhage on postoperative day 3. The vessels adhered the cyst had been pulled into the pituitary fossa, causing an aneurysm.
April 19, 2017: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/28410953/spontaneous-cerebrospinal-fluid-fistula-in-the-clivus
#6
A Codina Aroca, J R Gras Cabrerizo, M De Juan Delago, H Massegur Solench
INTRODUCTION: Spontaneous cerebrospinal fluid (CSF) fistulas are infrequent and only 10 cases in the literature have been located in the clivus. We describe two new cases of CSF fistulas in this site and review the literature. CASE REPORT: The first patient was a 52-year-old woman referred to our centre for intermittent rhinorrhea that had been diagnosed after an episode of meningitis. The second case was a 69-year-old man who was visited for rhinorrhea of one-year duration; he also developed meningitis during the preoperative study...
April 11, 2017: European Annals of Otorhinolaryngology, Head and Neck Diseases
https://www.readbyqxmd.com/read/28403108/analyses-and-treatments-of-postoperative-nasal-complications-after-endonasal-transsphenoidal-resection-of-pituitary-neoplasms
#7
You Cheng, Fei Xue, Tian-You Wang, Jun-Feng Ji, Wei Chen, Zhi-Yi Wang, Li Xu, Chun-Hua Hang, Xin-Feng Liu
In this study, we analyze and discuss the treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms (PNs). We performed 129 endonasal transsphenoidal resections of PNs and analyzed and treated cases with nasal complications. After endonasal transsphenoidal resection of PNs, there were 26 cases of postoperative nasal complications (20.1%), including nasal hemorrhage (4.8%), cerebrospinal fluid rhinorrhea (6.9%), sphenoid sinusitis (2.3%), atrophic rhinitis (1...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28392496/preoperative-evaluation-of-the-interface-between-tuberculum-sellae-meningioma-and-the-optic-nerves-on-fast-imaging-with-steady-state-acquisition-for-extended-endoscopic-endonasal-transsphenoidal-surgery
#8
Yasuhiko Hayashi, Daisuke Kita, Issei Fukui, Yasuo Sasagawa, Masahiro Oishi, Osamu Tachibana, Fumiaki Ueda, Mitsutoshi Nakada
INTRODUCTION: Endoscopic endonasal transsphenoidal surgery (EETS) is increasingly applied to treat tuberculum sellae meningiomas. However, if the tumor adheres firmly to the optic nerve, dissection of the interface between both structures should be prudent to preserve visual function. The purpose of this study was to investigate whether tumor adhesion to the optic nerve can be predicted preoperatively by fast imaging with steady-state acquisition (FIESTA). METHODS: Twenty-two patients with tuberculum sellae meningioma treated with EETS were retrospectively identified...
April 6, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28389053/non-functioning-pituitary-adenoma-underwent-surgery-a-multicenter-retrospective-study-over-the-last-four-decades-1977-2015
#9
Pedro Iglesias, Karina Arcano, Vanessa Triviño, Paula García-Sancho, Juan José Díez, Fernando Cordido, Carles Villabona
OBJECTIVE: To assess clinical features, diagnostic procedures, therapies and outcomes in patients with clinically non-functioning pituitary adenomas (NFPAs) surgically treated over the last four decades. DESIGN AND METHODS: A multicenter retrospective study in NFPA patients periodically followed up in specialized neuroendocrinology units who underwent surgery in the period 1977-2015 was performed. RESULTS: A total of 131 patients were studied [66 women (50...
April 4, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28387628/endonasal-endoscopic-pituitary-surgery-in-the-elderly
#10
Peter J Wilson, Sacit B Omay, Ashutosh Kacker, Vijay K Anand, Theodore H Schwartz
OBJECTIVE Pituitary adenomas are benign, slow-growing tumors that cause symptoms either through mass effect or hormone overproduction. The decision to operate on a healthy young person is relatively straightforward. In the elderly population, however, the risks of complications may increase, rendering the decision more complex. Few studies have documented the risks of surgery using the endonasal endoscopic approach in a large number of elderly patients. The purpose of this study was to audit a single center's data regarding outcomes of purely endoscopic endonasal transsphenoidal resection of pituitary adenomas in elderly patients and to compare them to the current literature...
April 7, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28377801/current-best-practice-in-the-management-of-patients-after-pituitary-surgery
#11
REVIEW
Alessandro Prete, Salvatore Maria Corsello, Roberto Salvatori
Sellar and parasellar masses are a common finding, and most of them are treated surgically via transsphenoidal approach. This type of surgery has revolutionized the approach to several hypothalamic-pituitary diseases and is usually effective, and well-tolerated by the patient. However, given the complex anatomy and high density of glandular, neurological and vascular structures in a confined space, transsphenoidal surgery harbors a substantial risk of complications. Hypopituitarism is one of the most frequent sequelae, with central adrenal insufficiency being the deficit that requires a timely diagnosis and treatment...
March 2017: Therapeutic Advances in Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28368500/long-term-endocrine-outcomes-following-endoscopic-endonasal-transsphenoidal-surgery-for-acromegaly-and-associated-prognostic-factors
#12
Harish Babu, Alicia Ortega, Miriam Nuno, Aaron Dehghan, Aaron Schweitzer, H Vivien Bonert, John D Carmichael, Odelia Cooper, Shlomo Melmed, Adam N Mamelak
BACKGROUND: Long-term remission rates from endoscopic transsphenoidal surgery for acromegaly and their relationship to prognostic indicators of disease aggressiveness are not well documented. OBJECTIVE: To investigate long-term remission rates in patients with acromegaly after endoscopic transsphenoidal surgery, and correlate this with molecular and radiographic markers of disease aggressiveness. METHODS: We identified all patients undergoing endoscopic transsphenoidal surgery for acromegaly from 2005 to 2013 at Cedars-Sinai Pituitary Center...
March 29, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28363833/postoperative-neurosurgical-infection-rates-after-shared-resource-intraoperative-magnetic-resonance-imaging-a-single-center-experience-with-195-cases
#13
Nikolaj Dinevski, Johannes Sarnthein, Flavio Vasella, Jorn Fierstra, Athina Pangalu, David Holzmann, Luca Regli, Oliver Bozinov
OBJECTIVE: To determine the rate of surgical site infections (SSI) in neurosurgical procedures involving a shared-resource intraoperative magnetic resonance imaging (ioMRI) scanner at a single institution derived from a prospective clinical quality management database METHODS: All consecutive neurosurgical procedures that were performed with a high-field, two-room ioMRI between April 2013 and June 2016 were included (N=195; 109 craniotomies and 86 endoscopic transsphenoidal procedures)...
March 28, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28347892/transcranial-evacuation-of-atypical-progressive-supradiaphragmatic-hematoma-after-transsphenoidal-complete-resection-of-pituitary-adenoma
#14
Hussam Metwali, Rudolf Fahlbusch
OBJECTIVE: Supradiaphragmatic hematoma is a special type of hematomas after transsphenoidal resection (TS) of pituitary adenoma that required special management. METHODS: two patients suffered from symptomatic supradiaphragmatic hematomas after TS total resection of pituitary adenomas in the absence of vascular anomalies. Both patients also developed hydrocephalus at the time of diagnosis of the hematoma. The initial endoscopic endonasal inspection revealed the absence of subdiaphragmatic bleeding...
March 24, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28332874/long-term-outcome-of-the-different-treatment-alternatives-for-recurrent-and-persistent-cushing-s-disease
#15
Ana Laura Espinosa-de-Los-Monteros, Ernesto Sosa-Eroza, Etual Espinosa, Victoria Mendoza, Rocio Arreola, Moises Mercado
BACKGROUND: Treatment alternatives for persistent and recurrent Cushing's disease (CD) include pituitary surgical reintervention, radiotherapy, pharmacotherapy and bilateral adrenalectomy (BA). The decision of which of these alternatives is better suited for the individual patient rests on clinical judgment and the availability of resources. OBJECTIVE: To evaluate the long-term efficacy of the different secondary interventions for persistent and recurrent Cushing's disease...
March 23, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28326242/nasal-lobular-capillary-hemangioma-as-a-complication-after-an-endoscopic-transsphenoidal-gonadotrophin-producing-pituitary-adenoma-resection
#16
Dalila Forte, Amets Sagarribay Irañeta, Anabela Nabais, António Figueiredo, Manuela Mafra, Victor Gonçalves
Background Lobular capillary hemangioma is a rare benign tumor, most frequently located in the head or neck region, the nasal cavity being uncommonly affected. Its etiopathogenesis is not fully established, although traumatic and hormonal factors have been implied. Case Description A 50-year-old female patient underwent an uneventful endoscopic transsphenoidal removal of a pituitary cystic macroadenoma at our institution. Nasal packing was used in postoperative hemostasis. Histopathology was compatible with a gonadotrophin-producing adenoma...
January 2017: Journal of Neurological Surgery Reports
https://www.readbyqxmd.com/read/28323961/normalized-early-post-operative-cortisol-and-acth-values-predict-nonremission-after-surgery-for-cushing-s-disease
#17
David Asuzu, Grégoire P Chatain, Christina Hayes, Sarah Benzo, Raven McGlotten, Meg Keil, Andrea Beri, Susmeeta T Sharma, Lynnette Nieman, Maya Lodish, Constantine Stratakis, Russell R Lonser, Edward H Oldfield, Prashant Chittiboina
Context: Perioperative increases in adrenocorticotropic hormone (ACTH) and cortisol mimic corticotropin releasing hormone (CRH) stimulation testing. This phenomenon may help identify patients with residual adenoma after transsphenoidal surgery (TSS) for Cushing's disease (CD). Objective: To predict non-remission after TSS for CD. Design: Retrospective case control study of patients treated at a single center from December 2003 till July 2016...
March 15, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28321378/hemi-transseptal-approach-for-pituitary-surgery-a-follow-up-study
#18
Naif Fnais, Salvatore Di Maio, Susan Edionwe, Anthony Zeitouni, Denis Sirhan, Constanza J Valdes, Marc A Tewfik
Objectives The hemi-transseptal (Hemi-T) approach was developed to overcome the potential drawbacks of the nasoseptal flap (NSF) in endoscopic endonasal transsphenoidal skull base surgery. In this study, we describe further refinements on the Hemi-T approach, and report long-term outcomes as compared with traditional methods of skull base reconstruction. Design A retrospective case-control study. Setting Montreal Neurological Institute and Jewish General Hospital, Montreal, Canada. Participants Patients who underwent endoscopic endonasal transsphenoidal approach to skull base pathology...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321371/anatomic-variations-in-pituitary-endocrinopathies-implications-for-the-surgical-corridor
#19
Edward C Kuan, Frederick Yoo, Won Kim, Karam W Badran, Thomas E Heineman, Ali R Sepahdari, Marvin Bergsneider, Marilene B Wang
Objectives/Hypotheses Functioning pituitary adenomas may produce endocrinopathies such as acromegaly and Cushing syndrome. Both conditions lead to characteristic anatomic variations as a result of hormonally induced abnormal soft tissue deposition. We evaluate the anatomic differences between acromegalics and Cushing disease patients and compare these dimensions to controls. Design Radiographic review of preoperative magnetic resonance images (MRI) of the pituitary gland. Setting Tertiary academic medical center...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28301972/efficacy-of-transsphenoidal-surgery-in-achieving-biochemical-cure-of-growth-hormone-secreting-pituitary-adenomas-among-patients-with-cavernous-sinus-invasion-a-systematic-review-and-meta-analysis
#20
REVIEW
Vanessa Briceno, Hasan A Zaidi, Joanne A Doucette, Kaho B Onomichi, Amer Alreshidi, Rania A Mekary, Timothy R Smith
OBJECTIVES: Growth hormone-secreting pituitary adenomas in adults can result in severe craniofacial disfigurement and potentially fatal medical complications. Surgical resection leading to remission of the disease is dependent on complete surgical resection of the tumor. Lesions that invade the cavernous sinus may not be safely accessible via an endonasal transsphenoidal surgery (TSS), and the rates of biochemical remission of patients with residual disease vary widely in the literature...
May 2017: Neurological Research
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