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Transsphenoidal Surgery

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
J N Wang, L X Wang, W Lian, B Xing, Y Yao, M Feng, R Z Wang
Objective: To investigate the clinical characteristics and treatment of pituitary adenomas of childhood and adolescence. Methods: Thisarticle was a retrospective study of 140 pituitary adenomas of childhood and adolescence that was admitted into Peking Union Medical College Hospital from December 1987 to December 2014, whose clinical manifestations, hormone secretions, images, pathological types, surgical complications and follow-ups were studied. Results: A total of 58 (41.4%) males and 82 females (58.6%) were included, whose mean age was 12...
October 11, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Toshihiro Ogiwara, Tetsuyoshi Horiuchi, Alhusain Nagm, Tetsuya Goto, Kazuhiro Hongo
PURPOSE: It is generally accepted that dopamine agonists (DA) represent the first-line treatment for most patients with prolactinoma, and patients become candidates for surgical intervention when DA is contraindicated. Surgical indication for cystic prolactinoma remains controversial. This study was performed to investigate the significance of surgery for cystic prolactinoma. METHODS: A total of 28 patients that underwent transsphenoidal resection of prolactinoma between February 2004 and May 2016 were reviewed...
October 18, 2016: Pituitary
Katsuhiro Mizutani, Takenori Akiyama, Masahiro Toda, Tokunori Kanazawa, Dai Kamamoto, Kazunari Yoshida
BACKGROUND: The endoscopic transclival approach is a method for reaching the anterior side of the brainstem. In making this approach, bleeding from the basilar plexus is often observed when cutting the dura overlying the clivus; controlling such bleeding is essential. CASE DESCRIPTION: We performed a transvenous embolization of the basilar plexus before making the transclival approach. After embolization, bleeding from the basilar plexus during the operation decreased considerably...
October 14, 2016: World 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
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)
Nidan Qiao, Zhao Ye, Xuefei Shou, Yongfei Wang, Shiqi Li, Min Wang, Yao Zhao
OBJECTIVE: The relationship between functional and structural measurements is of fundamental importance in monitoring treatment and progression in patients with pituitary adenoma. In the present study, we examined the association between longitudinal changes in standard automated perimetry (SAP), retinal nerve fiber layer (RNFL) thickness and multifocal visual evoked potential (mfVEP) amplitude after transsphenoidal surgery. METHODS: Thirty patients with pituitary adenoma were recruited from Huashan Hospital between September 2010 and January 2014...
September 6, 2016: Clinical Neurology and Neurosurgery
Jenny X Chen, Blake C Alkire, Allen C Lam, William T Curry, Eric H Holbrook
Objectives While bacterial meningitis is a concerning complication after endoscopic skull base surgery, the diagnosis can be made without consideration for aseptic meningitis. This article aims to (1) present a patient with recurrent craniopharyngioma and multiple postoperative episodes of aseptic meningitis and (2) discuss the diagnosis and management of aseptic meningitis. Design Case report and literature review. Results A 65-year-old female patient with a symptomatic craniopharyngioma underwent transsphenoidal resection...
October 2016: Journal of Neurological Surgery Reports
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
Lu Gao, Xiaopeng Guo, Rui Tian, Qiang Wang, Ming Feng, Xinjie Bao, Kan Deng, Yong Yao, Wei Lian, Renzhi Wang, Bing Xing
PURPOSE: Pituitary abscess (PA) is rare and commonly described in case reports or small case series. This study aimed to better determine salient clinical manifestations related to the diagnosis and appropriate treatment of PA using by far the largest case series of this disease. METHODS: A total of 6361 consecutive patients underwent surgery for pituitary diseases in Peking Union Medical College Hospital between January 1991 and December 2013. Among this cohort, sixty-six patients were diagnosed with PA based on both intraoperative findings and postoperative histopathological evidence...
September 30, 2016: Pituitary
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
Galina Yordanova, Lee Martin, Farhad Afshar, Ian Sabin, Ghassan Alusi, Nicholas P Plowman, Fiona Riddoch, Jane Evanson, Matthew Matson, Ashley B Grossman, Scott A Akker, John P Monson, William M Drake, Martin O Savage, Helen L Storr
PURPOSE: Pediatric Cushing's disease (CD) is rare and there are limited data on the long-term outcomes. We assessed CD recurrence, body composition, pituitary function and psychiatric comorbidity in a cohort of pediatric CD patients. METHODS: Retrospective review of 21 CD patients, mean age at diagnosis 12.1 years (5.7-17.8), managed in our center between 1986 and 2010. Mean follow-up from definitive treatment was 10.6 years (2.9-27.2). RESULTS: Fifteen patients were in remission following transsphenoidal surgery (TSS) and 5 were in remission following TSS + external pituitary radiotherapy (RT)...
September 27, 2016: Pituitary
M P Powell, G J Narimova, Z Ju Halimova
Transsphenoidal surgery (TSS) was introduced into the Republic of Uzbeksistan in 2005, and has been developed there since. The principal center for the management of all pituitary disease is in a single site for a nation of approxiamately 30 million population. Results in the surgery of Cushing's disease (CD) are a marker of surgical technical skill in TSS. All previously published series come from the developed world where sophisticated investigations and management are available. Many of these investigations are not available in Uzbekistan...
September 23, 2016: World Neurosurgery
Hasan A Zaidi, David J Cote, Joseph P Castlen, William T Burke, Yong-Hui Liu, Timothy R Smith, Edward R Laws
BACKGROUND: Primary lactotroph disinhibition, or stalk effect, occurs when mechanical compression of the pituitary stalk disrupts the tonic inhibition by dopamine released by the hypothalamus. The resolution of pituitary stalk effect-related hyperprolactinemia post-operatively has not been studied in a large cohort of patients. We performed a retrospective review to investigate the time course of recovery of lactotroph disinhibition after transsphenoidal surgery. METHODS: Medical records were retrospectively reviewed for all patients undergoing transsphenoidal surgery with the senior author from April 2008 to November 2014...
September 23, 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 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
D A Vassiliadi, M Balomenaki, A Asimakopoulou, E Botoula, M Tzanela, S Tsagarakis
CONTEXT: Cushing's disease (CD) has a significant relapse rate after successful transsphenoidal surgery (TSS). Many CD patients respond aberrantly to desmopressin testing (DT). Disappearance of this response post-surgery may suggest complete removal of abnormal corticotrophs and lower possibility of recurrence. OBJECTIVE: The utility of post-operative DT to predict long-term outcome compared to the widely used post-operative cortisol (Cort) level. DESIGN: Retrospective analysis...
September 23, 2016: Journal of Clinical Endocrinology and Metabolism
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