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Shafiq I, Williams ZR, Vates GE. Advancement in perioperative management of pituitary adenomas-Current concepts and best practices. J Neuroendocrinol 2024:e13427. [PMID: 38964869 DOI: 10.1111/jne.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/30/2024] [Accepted: 06/16/2024] [Indexed: 07/06/2024]
Abstract
Pituitary adenomas are very common representing 18.1% of all brain tumors and are the second most common brain pathology. Transsphenoidal surgery is the mainstay of treatment for all pituitary adenomas except for prolactinomas which are primarily treated medically with dopamine agonists. A thorough endocrine evaluation of pituitary adenoma preoperatively is crucial to identify hormonal compromise caused by the large sellar mass, identifying prolactin-producing tumors and comorbidities associated with Cushing and acromegaly to improve patient care and outcome. Transsphenoidal surgery is relatively safe in the hands of experienced surgeons, but still carries a substantial risk of causing hypopituitarism that required close follow-up in the immediate postoperative period to decrease mortality. A multidisciplinary team approach with endocrinologists, ophthalmologists, and neurosurgeons is the cornerstone in the perioperative management of pituitary adenomas.
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Affiliation(s)
- Ismat Shafiq
- Division of Endocrinology, Diabetes, and Metabolism, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Zoë R Williams
- Department of Ophthalmology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - G Edward Vates
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
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Yataco-Wilcas CA, Diaz-Llanes BE, Coasaca-Tito YS, Lengua-Vega LA, Salazar-Campos CE. Morphometric analysis of transsphenoidal surgery in Peruvian population. Surg Neurol Int 2024; 15:156. [PMID: 38840596 PMCID: PMC11152524 DOI: 10.25259/sni_239_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/16/2024] [Indexed: 06/07/2024] Open
Abstract
Background Transsphenoidal surgery has become a key element in the approach to skull base pathologies. The objective of the study was to explore the morphometry of the sphenoidal region in the Peruvian population, with an emphasis on understanding its specific anatomical characteristics and providing quantitative data for the planning of transsphenoidal surgery. Methods A cross-sectional study included a random sample of 81 cases of healthy individuals who presented to the Radiology Department of a Private Hospital Center in Peru over 1 year. Skull computed tomography scans without contrast were performed, and a detailed morphometric analysis was conducted by an expert neurosurgeon, including measurements of four parameters to evaluate the anatomy of the craniofacial region. Results Most participants exhibited complete sellar pneumatization, followed by incomplete sellar pneumatization, while conchal pneumatization was rare. Significant differences were found between men and women in the distance from the nasal opening to the dorsum of the sella turcica. No significant gender differences were observed in other anatomical measurements or significant changes with age in anatomical measurements. Conclusion Morphometric analysis provides crucial data for the precise customization of surgical interventions in the Peruvian population, especially in transsphenoidal surgery. The results highlight the importance of considering individual anatomical differences and gender variability during surgical planning. Morphometry emerges as a valuable tool to enhance the quality and safety of transsphenoidal surgery by adapting surgical strategies to the specific anatomical dimensions of each patient.
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Hassan RMA, Almalki YE, Basha MAA, Alduraibi SK, Hassan AH, Aboualkheir M, Almushayti ZA, Alduraibi AK, Amer MM, Basha AMA, Refaat MM. Predicting the Consistency of Pituitary Macroadenomas: The Utility of Diffusion-Weighted Imaging and Apparent Diffusion Coefficient Measurements for Surgical Planning. Diagnostics (Basel) 2024; 14:493. [PMID: 38472965 DOI: 10.3390/diagnostics14050493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Understanding the consistency of pituitary macroadenomas is crucial for neurosurgeons planning surgery. This retrospective study aimed to evaluate the utility of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) as non-invasive imaging modalities for predicting the consistency of pituitary macroadenomas. This could contribute to appropriate surgical planning and therefore reduce the likelihood of incomplete resections. The study included 45 patients with pathologically confirmed pituitary macroadenomas. Conventional MRI sequences, DWIs, ADC maps, and pre- and post-contrast MRIs were performed. Two neuroradiologists assessed all of the images. Neurosurgeons assessed the consistency of the tumor macroscopically, and histopathologists examined it microscopically. The MRI findings were compared with postoperative data. According to the operative data, macroadenomas were divided into the two following categories based on their consistency: aspirable (n = 27) and non-aspirable tumors (n = 18). A statistically significant difference in DWI findings was found when comparing macroadenomas of different consistencies (p < 0.001). Most aspirable macroadenomas (66.7%) were hyperintense according to DWI and hypointense on ADC maps, whereas most non-aspirable macroadenomas (83.3%) were hypointense for DWI and hyperintense on ADC maps. At a cut-off value of 0.63 × 10-3 mm2/s, the ADC showed a sensitivity of 85.7% and a specificity of 75% for the detection of non-aspirable macroadenomas (AUC, 0.946). The study concluded that DWI should be routinely performed in conjunction with ADC measurements in the preoperative evaluation of pituitary macroadenomas. This approach may aid in surgical planning, ensure that appropriate techniques are utilized, and reduce the risk of incomplete resection.
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Affiliation(s)
- Rania Mostafa A Hassan
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Yassir Edrees Almalki
- Division of Radiology, Department of Internal Medicine, Medical College, Najran University, Najran 61441, Saudi Arabia
| | | | | | - Alshehri Hanan Hassan
- Internal Medicine Department, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia
| | - Mervat Aboualkheir
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia
| | - Ziyad A Almushayti
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Alaa K Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Buraidah 52571, Saudi Arabia
| | - Mona M Amer
- Department of Neurology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
| | | | - Mona Mohammed Refaat
- Department of Diagnostic Radiology, Faculty of Human Medicine, Zagazig University, Zagazig 44519, Egypt
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Ashfaq A, Bokhari SFH, Rehman A, Baluch AB, Mohamed Abdul Raheem AB, Almomani MM, Al-Shaikhly FF, I Kh Almadhoun MK, Kamran M, Shehzad A. Navigating the Surgical Landscape: A Comprehensive Analysis of Endoscopic vs. Microscopic Transsphenoidal Pituitary Surgery Outcomes. Cureus 2024; 16:e53633. [PMID: 38449928 PMCID: PMC10915695 DOI: 10.7759/cureus.53633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/08/2024] Open
Abstract
Pituitary surgery, a critical intervention for various pituitary disorders, has sparked ongoing debates regarding the preference between endoscopic and microscopic transsphenoidal approaches. This systematic review delves into the outcomes associated with these techniques, taking into account the recent advancements in neurosurgery. The minimally invasive nature of endoscopy, providing improved visualization and reduced morbidity, stands in contrast to the well-established track record of the conventional microscopic method. Examining outcomes for disorders such as Cushing's disease and acromegaly, the review synthesizes evidence from Denmark, Bulgaria, and China. Noteworthy advantages of endoscopy encompass higher resection rates, shorter surgery durations, and fewer complications, endorsing its effectiveness in pituitary surgery. While emphasizing the necessity for prospective trials, the review concludes that endoscopic approaches consistently showcase favorable outcomes, influencing the ongoing discourse on the optimal surgical strategies for pituitary disorders.
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Affiliation(s)
- Abdullah Ashfaq
- Surgery, Gujranwala Medical College Teaching Hospital, Gujranwala, PAK
| | | | | | - Amna B Baluch
- Internal Medicine, Universidad Autónoma de Guadalajara, Guadalajara, MEX
| | | | | | | | | | | | - Ahsan Shehzad
- Surgery, King Edward Medical University, Lahore, PAK
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Chavez-Herrera VR, Desai R, Gel G, Nilchian P, Schwartz TH. Endonasal endoscopic surgery for pituitary adenomas. Clin Neurol Neurosurg 2024; 237:108172. [PMID: 38359520 DOI: 10.1016/j.clineuro.2024.108172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/22/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
Pituitary adenomas are slow-growing, benign intracranial tumors that can be characterized as functional (hormone-producing) or non-functional (non-hormone producing). Symptoms therefore arise from either endocrinologic abnormalities or mass effect on surrounding structures resulting in symptoms such as visual impairment and headache. In the last two decades, technical innovations have shifted surgical resection of such adenomas to endoscopic endonasal approaches. In this review, we describe the evolving approach to pituitary adenomas in the modern endoscopic era, including preoperative multidisciplinary review, relevant surgical anatomy, and a description of the technical nuances of standard and expanded approaches to the anterior skull base.
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Affiliation(s)
- Victor Ramzes Chavez-Herrera
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Rupen Desai
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Gülce Gel
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Parsa Nilchian
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
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Bharadwaj S, Gopalakrishna KN, Akash VS, Konar S, Srinivasaiah B, Kamath S. Perioperative care practices and outcomes of intracranial neurosurgery: Experience at a dedicated neurosciences hospital in a developing country. J Anaesthesiol Clin Pharmacol 2023; 39:622-627. [PMID: 38269186 PMCID: PMC10805212 DOI: 10.4103/joacp.joacp_305_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/25/2022] [Accepted: 12/14/2022] [Indexed: 01/26/2024] Open
Abstract
Background and Aims Understanding of perioperative care practices and early postoperative outcomes helps minimize potentially preventable perioperative complications while supporting systemic and neurological well-being. The objective of this prospective study was to evaluate the perioperative care practices and early postoperative outcomes of cranial neurosurgery at a high-volume tertiary care neurosciences hospital in India. We also aimed to see if the care elements differed depending on the surgical approach. We hypothesized that care elements and outcomes are likely to be different between major surgical approaches. Material and Methods This was a prospective observational study of consecutive adult neurosurgical patients who underwent elective surgeries for intracranial pathologies over a period of six months from October 2020 to March 2021 at a tertiary care neurosciences center in India. Perioperative data about intraoperative care elements and early postoperative outcomes till the third day after surgery were collected. Results Incidence of blood loss >1 L was significantly (P = 0.07) higher after infratentorial surgery (26%, N = 17). Incidence of intraoperative and postoperative desaturation was more after transnasal surgery (6%, N = 2, P = 0.002, and 9%, N = 3, P = 0.01, respectively). Conclusion This study informs the early perioperative care practices of neurosurgical patients from a dedicated neurosciences hospital in a developing world. We observed that transnasal surgery was associated with more perioperative adverse events and slower convalescence compared to supra- and infratentorial surgeries despite being a considerably less invasive surgery.
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Affiliation(s)
- Suparna Bharadwaj
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - VS Akash
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Bharath Srinivasaiah
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Sriganesh Kamath
- Department of Neuroanesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Albaharna H, Alqurashi A, Alshareef M, Alromaih S, Alrasheed AS, Alroqi A, Ajlan A, Alsaleh S. Impact of Concurrent Chronic Rhinosinusitis on Complication Rates after Endonasal Endoscopic Skull Base Surgery: A Single-Center Experience. J Neurol Surg B Skull Base 2023; 84:507-512. [PMID: 37671295 PMCID: PMC10477013 DOI: 10.1055/s-0042-1755602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 06/20/2022] [Indexed: 10/15/2022] Open
Abstract
Objectives Preoperative planning of endoscopic skull base surgery (ESBS) is essential. The safety of performing surgery before managing sinus pathologies including concurrent chronic rhinosinusitis (CRS) in patients undergoing ESBS has been questioned. The current study aimed to evaluate and compare the complication rates between patients with and without CRS undergoing ESBS. Design This is a retrospective study. Setting Present study was conducted at tertiary referral center. Participants We included all patients who underwent ESBS between March 2015 and March 2021. However, patients who had surgical revision for remnant tumor, primary sinonasal tumor excision, and cerebrospinal fluid (CSF) leakage repair were excluded. The presence of concurrent CRS was determined according to the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 (EPOS 2020) criteria by reviewing electronic charts about the preoperative clinical assessment and CT scan images of the paranasal sinuses. Then, the incidence rates of postoperative meningitis, CSF leakage, and surgical site infection were compared between patients with and without concurrent CRS undergoing ESBS. Main Outcome Measures Postoperative complication rates in patients underwent ESBS with and without CRS. Results From a total of 130 ESBS cases, 99 patients were included in this study. Among them, 24 had concurrent CRS. One patient presented with postoperative meningitis, one with CSF leakage, and two with surgical site infections. The incidence rate of postoperative meningitis, CSF leakage, and surgical site infection did not significantly differ between patients with and without concurrent CRS. Conclusion Concurrent CRS is not a contraindication for ESBS. Moreover, simultaneous endoscopic sinus surgery can safely be performed without additional morbidity in ESBS.
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Affiliation(s)
- Hussain Albaharna
- Department of Otolaryngology, Head and Neck Surgery, Qatif Central Hospital, Qatif City, Saudi Arabia
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ashwag Alqurashi
- Department of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alshareef
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Otolaryngology, Head and Neck Surgery, Khamis Mushait General Hospital, Khamis Mushait City, Saudi Arabia
| | - Saud Alromaih
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz S. Alrasheed
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmad Alroqi
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrazag Ajlan
- Department of Neurosurgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad Alsaleh
- Department of Otolaryngology, Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Tosi U, Guadix SW, Souweidane MM. Neuroendoscopy: The State of the Art. World Neurosurg 2023; 178:305-310. [PMID: 37803686 DOI: 10.1016/j.wneu.2023.07.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 10/08/2023]
Abstract
Over the past century, neuroendoscopy developed into a mainstay of neurosurgical practice, allowing for minimally invasive approaches to the ventricles, skull base, and spine. Its development, however, is far from over. Current challenges are inherent in the very feature that renders neuroendoscopy appealing-the small channels of the modern endoscope allow surgery to be performed with minimal tissue retraction, but they also make hemostasis and resection of large masses difficult. New optics allow for significantly improved image quality; yet open craniotomy often allows for 3-dimensional visualization and bimanual dissection and is part of everyday neurosurgical training. Finally, the utilization of neuroendoscopy remains limited, presenting ongoing challenges for neurosurgical teaching and achievement of technical mastery.
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Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA
| | - Sergio W Guadix
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA
| | - Mark M Souweidane
- Department of Neurological Surgery, NewYork-Presbyterian Weill Cornell Medicine, New York, New York, USA.
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Aldosari N, Alrashid S, Alshareeda AH, Alenezi A, Alenezi MY, Almutairi A, Aldweesan Y, Almajed F, Alshakhri A, Alwahhabi F, Almehmadi SA, Albzea W, Alsakka MA, Alhajaji R. Dexmedetomidine in Patients Undergoing Transsphenoidal Resection of Pituitary Adenoma: An Updated Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Cureus 2023; 15:e44132. [PMID: 37641722 PMCID: PMC10460480 DOI: 10.7759/cureus.44132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 08/31/2023] Open
Abstract
Dexmedetomidine has been widely studied in many surgical settings, with possible benefits in lowering anesthetic requirements, improving perioperative hemodynamic stability, and improving postoperative outcomes. This systematic review aims to evaluate the effects of dexmedetomidine in patients undergoing transsphenoidal resection of pituitary adenoma, shedding light on its potential as an adjunctive agent in anesthesia for this specific surgical population. In this review, we searched PubMed, Cochrane Library, Scopus, Web of Science, and Google Scholar from inception to July 20, 2023. A total of six randomized clinical trials (RCTs) investigating the effects of dexmedetomidine versus placebo in patients undergoing transsphenoidal resection of pituitary adenoma were included in this review. The outcomes of interest were extracted from the included studies as mean difference (MD) and standard deviation (SD), then analyzed using the Review Manager (RevMan, RevMan International Inc., New York, USA) software. Our literature search process retrieved 274 records. Of them, six studies were included in the meta-analysis. There was a significant difference between the dexmedetomidine group compared to the placebo group in terms of heart rate at the end of the surgery (MD = -16.5; CI = [-25.36 to -7.64]; P value = 0.0003) and after extubation (MD = -16.81; CI = [-23.18 to -10.43]; P values < 0.00001). Furthermore, dexmedetomidine significantly reduced the mean arterial blood pressure (MAP) at after both intubation and extubation (MD = -9.11 and -21.5; CI = [-13.56 to -4.65] and [-30.93 to -12.06]; P values < 0.00001). This systematic review and meta-analysis demonstrated that dexmedetomidine appears to have several potential benefits in patients undergoing transsphenoidal resection of pituitary adenoma. The use of dexmedetomidine was associated with reductions in heart rate, mean arterial blood pressure, blood loss, and duration of surgery, while showing no significant difference in propofol dose or time to extubation of the trachea.
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Affiliation(s)
- Nasser Aldosari
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Shahad Alrashid
- Pediatrics, Alsabah Hospital, Ministry of Health, Kuwait City, KWT
| | - Anwar H Alshareeda
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Abdulaziz Alenezi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Mohammad Y Alenezi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Abdulrahman Almutairi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Yousef Aldweesan
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Fay Almajed
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Abdulrazzaq Alshakhri
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Fai Alwahhabi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | | | - Wardah Albzea
- Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Mahmoud A Alsakka
- Otorhinolaryngology and Facial Plastic Surgery, Canadian Medical Center, Kuwait City, KWT
| | - Raghad Alhajaji
- Family Medicine, Alhajj Primary Health Care, Ministry of Health, Makkah, SAU
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Akbarpour M, Jalali MM, Akbari M, Nasirmohtaram S, Haddadi S, Habibi AF, Azad F. Investigation of the effects of intranasal desmopressin on the bleeding of the patients during open septorhinoplasty: A randomized double-blind clinical trial. Heliyon 2023; 9:e17855. [PMID: 37455992 PMCID: PMC10344754 DOI: 10.1016/j.heliyon.2023.e17855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023] Open
Abstract
Objectives Rhinoplasty is one of the most common cosmetic surgeries in the world. Lack of adequate local homeostasis may lead to excessive bleeding during the operation, which increases the time of operation and recovery period, and the prevalence of complications. This study investigated the effects of nasal desmopressin on the quality of the surgical field and the volume of bleeding during rhinoplasty. Materials and methods This double-blind randomized clinical trial was performed on 120 patients aged 18-40 years who were candidates for rhinoplasty. Patients were randomly divided into three groups: low-dose desmopressin group and high-dose desmopressin group and placebo group. Hemodynamic changes and surgical field based on BOEZAART criteria, and the volume of bleeding were calculated. Results In this study 115 women (95.8%) and 5 men (4.2%) participated. The mean age of patients was (27 ± 6.8). Bleeding volume in high dose desmopressin group was (21.7 cc ± 12.3), (27.7 cc ± 12.3) in low dose group, and (38.3 cc ± 12.3) in the placebo group, The difference in blood volume among the three groups was statistically significant with p < 0.005. Clean surgical field according to BOEZAART classification was marginally significant in both desmopressin groups. The differences in blood pressure, heart rate, blood and urine sodium, and hemoglobin before and after surgery between groups there not statistically significant. Conclusion Based on the results of the present study topical nasal spray desmopressin can reduce surgical field bleeding during rhinoplasty. To generalize the results to other surgeries in the ENT field it is recommended to conduct studies.
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Affiliation(s)
- Maliheh Akbarpour
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mir-Mohammad Jalali
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Akbari
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Sevil Nasirmohtaram
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Soudabeh Haddadi
- Anesthesiology Research Center, Department of Anesthesiology, Alzahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Faghih Habibi
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Fateme Azad
- Otorhinolaryngology Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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11
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Optimizing Perioperative Care in Transsphenoidal Pituitary Surgery: Considerations for Enhanced Recovery After Surgery. J Craniofac Surg 2023; 34:83-91. [PMID: 35968948 DOI: 10.1097/scs.0000000000008893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/04/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To identify key recommendations for maximizing the efficiency and efficacy of perioperative care in transsphenoidal pituitary surgery. METHODS The authors performed a comprehensive literature search of Enhanced Recovery After Surgery protocols implemented for patients undergoing transsphenoidal adenomectomy (TSA); individual recommendations were abstracted, and the evidence base thoroughly reviewed. RESULTS The authors identified 19 individual recommendations pertinent to the care of patients undergoing TSA, which were subdivided into preoperative (n=6), intraoperative (n=6), and postoperative (n=7) interventions. Key factors recommended for minimizing length of stay, preventing readmission, and improving patient outcomes included comprehensive patient education, multidisciplinary evaluation, avoidance of routine lumbar drain placement and nasal packing, and rigorous postoperative monitoring of pituitary function and salt-water imbalances. The overall level of evidence for 7/19 (37%) implemented recommendations was found to be low, suggesting a need for continued research in this patient population. CONCLUSION Several key interventions should be considered in the development of Enhanced Recovery After Surgery protocols for TSA, which may aid in further decreasing length of stay and promoting positive patient outcomes.
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Saleh S, Sullivan SE, Bellile E, Roxbury C, Das P, Hachem RA, Ackall F, Jang D, Celtikci E, Sahin MM, D'souza G, Evans JJ, Nyquist G, Khalafallah A, Mukherjee D, Rowan NR, Camp S, Choby G, Gompel JJV, Ghiam MK, Levine CG, Field M, Adappa N, Locke TB, Rassekh C, Sweis AM, Goyal N, Zacharia B, Wilson MN, Patel S, Gardner PA, Snyderman CH, Wang EW, Glancz LJ, Bagchi A, Dow G, Robertson I, Rangarajan SV, Michael LM, McKean EL. Retrospective Review of Surgical Site Infections after Endoscopic Endonasal Sellar and Parasellar Surgery: Multicenter Quality Data from the North American Skull Base Society. J Neurol Surg B Skull Base 2022; 83:579-588. [PMID: 36393885 PMCID: PMC9653291 DOI: 10.1055/a-1865-3202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/26/2022] [Indexed: 10/18/2022] Open
Abstract
Introduction Transnasal access to the anterior skull base provides a minimally invasive approach for sellar and parasellar masses compared with its open counterparts. The unique microbiome of the sinonasal mucosa provides distinct challenges not encountered with other cranial approaches. The use of antibiotics in these cases has not been standardized, and data remain scarce regarding infectious outcomes. Methods We conducted a multicenter retrospective analysis of shared quality data points for the endoscopic endonasal approach (EEA) for pituitary adenomas, along with other sellar and parasellar region masses that were included by participating institutions. Patient and operative characteristics, perioperative and postoperative antibiotic regimens and their durations, intraoperative and postoperative cerebrospinal fluid leak, and onset of postoperative meningitis and sinusitis were compared. Results Fifteen institutions participated and provided 6 consecutive months' worth of case data. Five hundred ninety-three cases were included in the study, of which 564 were pituitary adenomectomies. The incidences of postoperative meningitis and sinusitis were low (0.67 and 2.87% for all pathologies, respectively; 0.35% meningitis for pituitary adenomas) and did not correlate with any specific antibiotic regimen. Immunocompromised status posed an increased odds of meningitis in pituitary adenomectomies (28.6, 95% confidence interval [1.72-474.4]). Conclusions The results show no clear benefit to postoperative antimicrobial use in EEA, with further larger studies needed.
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Affiliation(s)
- Sara Saleh
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Stephen E. Sullivan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Emily Bellile
- Cancer Data Science, Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
| | - Christopher Roxbury
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, United States
| | - Paramita Das
- Department of Neurosurgery, University of Chicago, Chicago, Illinois, United States
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, United States
| | - Feras Ackall
- Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, United States
| | - David Jang
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emrah Celtikci
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Muammer Melih Sahin
- Department of Otolaryngology–Head and Neck Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Glen D'souza
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - James J. Evans
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Gurston Nyquist
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Adham Khalafallah
- Department of Neurosurgery, University of Miami/Jackson Health System, Miami, Florida, United States
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Nicholas R. Rowan
- Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Samantha Camp
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Garret Choby
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Jamie J. Van Gompel
- Department of Neurosurgery and Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
| | - Michael K. Ghiam
- Department of Otolaryngology, University of Miami, Miami, Florida, United States
| | - Corinna G. Levine
- Department of Otolaryngology, University of Miami, Miami, Florida, United States
| | - Melvin Field
- Orlando Neurosurgery, Orlando, Florida, United States
| | - Nithin Adappa
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Tran B. Locke
- Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Christopher Rassekh
- Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Auddie M. Sweis
- Division of Otolaryngology–Head and Neck Surgery, Northshore University Health System, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
| | - Neerav Goyal
- Department of Otolaryngology–Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Brad Zacharia
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Meghan N. Wilson
- Department of Otolaryngology–Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Shivam Patel
- Department of Otolaryngology–Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Paul A. Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Carl H. Snyderman
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Eric W. Wang
- Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Laurence Johann Glancz
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
- Manchester Skullbase Unit, Salford Royal Hospital, Manchester, United Kingdom
| | - Ananyo Bagchi
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Graham Dow
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Iain Robertson
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Sanjeet V. Rangarajan
- Department of Otolaryngology, Head-Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - L. Madison Michael
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Erin L. McKean
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, United States
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13
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Flukes S, Laufer I, Cracchiolo J, Geer E, Lin AL, Brallier J, Tsui V, Afonso A, Tabar V, Cohen MA. Integration of an enhanced recovery after surgery program for patients undergoing pituitary surgery. World J Otorhinolaryngol Head Neck Surg 2022; 8:330-338. [PMID: 36474665 PMCID: PMC9714042 DOI: 10.1016/j.wjorl.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/01/2021] [Indexed: 02/09/2023] Open
Abstract
Evidence-based enhanced recovery after surgery (ERAS) programs aim to improve patient outcomes and shorten hospital stays. The objective of this study is to describe the development, implementation, and evolution of an ERAS protocol to optimize the perioperative management for patients undergoing endoscopic skull base surgery for pituitary tumors. A systematic review of the literature was performed, best practices were discussed with stakeholders, and institutional guidelines were established and implemented. Key performance indicators (KPI) were measured and patient-reported outcome surveys were collected. The ERAS protocol was introduced successfully at our institution. We describe the process of initiation of the program and the perioperative management of our patients. We demonstrated the feasibility of integration of ERAS protocols for pituitary tumors with multidisciplinary engagement, with a particular emphasis on the use of data informatics and metrics to monitor outcomes. We expect that this approach will translate to improved quality of care for these often-complex patients.
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Affiliation(s)
- Stephanie Flukes
- Head and Neck Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Ilya Laufer
- Department of NeurosurgeryMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Jennifer Cracchiolo
- Head and Neck Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Eliza Geer
- Multidisciplinary Pituitary and Skull Base Tumor CenterMemorial Sloan Kettering Cancer CenterNew YorkNYUSA,Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Andrew L. Lin
- Multidisciplinary Pituitary and Skull Base Tumor CenterMemorial Sloan Kettering Cancer CenterNew YorkNYUSA,Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Jess Brallier
- Department of Anesthesiology and Critical Care MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Van Tsui
- Department of Anesthesiology and Critical Care MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Anoushka Afonso
- Department of Anesthesiology and Critical Care MedicineMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Viviane Tabar
- Department of NeurosurgeryMemorial Sloan Kettering Cancer CenterNew YorkNYUSA,Multidisciplinary Pituitary and Skull Base Tumor CenterMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
| | - Marc A. Cohen
- Head and Neck Service, Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkNYUSA,Multidisciplinary Pituitary and Skull Base Tumor CenterMemorial Sloan Kettering Cancer CenterNew YorkNYUSA
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14
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Overview of Pituitary Surgery. Otolaryngol Clin North Am 2022; 55:205-221. [DOI: 10.1016/j.otc.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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White A, Junior de Andrade E, Kshettry VR, Sindwani R, Recinos PF. Preoperative Workup for Patients with Pituitary Lesions. Otolaryngol Clin North Am 2022; 55:233-246. [DOI: 10.1016/j.otc.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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