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Dorismond C, Santarelli GD, Thorp BD, Kimple AJ, Ebert CS, Zanation AM. Heterogeneity in Outcome Reporting in Endoscopic Endonasal Skull Base Reconstruction: A Systematic Review. J Neurol Surg B Skull Base 2021; 82:506-521. [PMID: 34513556 DOI: 10.1055/s-0040-1714108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/17/2020] [Indexed: 10/23/2022] Open
Abstract
Objective Presently, there are no standards for reporting outcomes of endoscopic endonasal skull base reconstruction (ESBR). This is problematic as a lack of consistent reporting makes synthesizing findings in systematic reviews and meta-analysis challenging. Thus, the aim of this study was to systematically review and describe the patterns of reporting outcomes in ESBR as a foundation for developing reporting guidelines. Study Design Present study is a systematic review. Methods Embase, PubMed, CINAHL, Cochrane Library, and Web of Science were searched for all publications with ≥25 patients and a focus on ESBR. The reporting patterns of each study's variables and outcomes were assessed. Results A total of 112 studies were included in the review. The most commonly reported demographic variables were the number of included patients ( n = 112, 100%) and types of pathologies treated ( n = 104, 92.9%). Meanwhile, the most routinely described preoperative variable was history of prior treatment ( n = 48, 42.9%). Type of reconstruction was a commonly reported intraoperative variable ( n = 110, 98.2%), though the rate of intraoperative cerebrospinal fluid (CSF) leak was noted in only 76 studies (67.9%). With regard to postoperative outcomes, postoperative CSF leak rate was routinely provided ( n = 101, 90.2%), but reporting of other surgical complications was more inconsistent. Ultimately, of the 43 variables and outcomes reviewed, a median of 12 (range: 4-22) was reported in each study. Conclusion There is significant heterogeneity in the outcomes reported in studies relating to ESBR. This highlights the need for the development of standard reporting guidelines to minimize bias and improve interstudy comparability.
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Affiliation(s)
- Christina Dorismond
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Griffin D Santarelli
- Department of Otolaryngology, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, United States
| | - Brian D Thorp
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Adam J Kimple
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Charles S Ebert
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Adam M Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
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Cunha MLVD, Borba LAB, Boguszewski CL. Random Gh and Igf-I levels after transsphenoidal surgery for acromegaly: relation with long-term remission. Endocrine 2020; 68:182-191. [PMID: 32078118 DOI: 10.1007/s12020-020-02227-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/11/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the role of IGF-I and random GH measurements 3 months after transsphenoidal surgery (TSS) in predicting long-term remission in acromegaly patients. METHODS Retrospective analysis of 54 acromegaly patients who underwent TSS with the same neurosurgery team. Random GH and IGF-I values evaluated 3 months after TSS were related to long-term outcomes. The initiation of adjuvant therapy at any time defined surgical failure. RESULTS At 3 months, 14 (25.9%) patients had controlled disease (CD; normal IGF-I and GH < 1.0 µg/L), 25 (46.3%) had uncontrolled disease (UD; high IGF-I and GH), and 15 (27.8%) had biochemical discrepancies (BD): 12 BDI (normal IGF-I + GH ≥ 1.0 μg/L) and 3 BDII (high IGF-I + GH < 1.0 μg/L). All patients of the CD group, 2 of the UD, 11 of the BDI, and 2 of the BDII, progressed with long-term remission and had IGF-I ≤ 1.25-fold the Upper Limit of Normal (ULN), in contrast with all cases of surgical failure where IGF-I was ≥1.3-fold ULN. Only one patient with normal IGF-I had recurrence, resulting in 100% sensitivity and 96% specificity of post-surgical IGF-I ≤ 1.25-fold ULN to predict long-term remission, observed in 54% of our cohort. Post-surgical random GH ≥ 1.7 µg/L was the best cutoff to identify surgical failure, but its accuracy to predict long-term outcomes was limited. CONCLUSIONS IGF-I levels ≤ 1.25-fold ULN 3 months after TSS was the best guide for long-term remission in acromegaly patients with both initial surgical failure and discrepant biochemical results.
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Affiliation(s)
- Marcelo Lemos Vieira da Cunha
- Department of Neurosurgery, Hospital de Clínicas, Universidade Federal do Parana, Rua General Carneiro 181 - Alto da Glória, Curitiba, PR, 80060-900, Brazil
| | - Luis Alencar Biurrum Borba
- Department of Neurosurgery, Hospital de Clínicas, Universidade Federal do Parana, Rua General Carneiro 181 - Alto da Glória, Curitiba, PR, 80060-900, Brazil
| | - Cesar Luiz Boguszewski
- Endocrine Division (SEMPR), Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Parana, Avenida Agostinho Leao Junior, 285, Curitiba, PR, 80030-110, Brazil.
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Romero ADCB, Lal Gangadharan J, Bander ED, Gobin YP, Anand VK, Schwartz TH. Managing Arterial Injury in Endoscopic Skull Base Surgery: Case Series and Review of the Literature. Oper Neurosurg (Hagerstown) 2019; 13:138-149. [PMID: 28931251 DOI: 10.1227/neu.0000000000001180] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/18/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The most feared complications following endoscopic endonasal skull base surgery are arterial vascular injuries. Previously published literature is restricted to internal carotid artery injuries. The ideal method for controlling arterial bleeding during this kind of procedure is debated, and a variety of techniques have been advocated. OBJECTIVE To evaluate the management and outcome following intraoperative arterial injury during endoscopic endonasal skull base surgery. METHODS We performed a retrospective review of a prospectively acquired database of consecutive endonasal endoscopic surgeries at the New York-Presbyterian Hospital/Weill Cornell Medical Center from December 2003 to June 2015 and identified all cases of arterial injury. RESULTS Of 800 cases, there were 4 arterial injuries (0.5%), of which only one involved the internal carotid artery (ICA), for a risk of 0.125%. The other 3 involved the ophthalmic artery, anterior communicating artery, and A1 segment of the anterior cerebral artery. In all cases, definitive treatment involved occlusion of the artery either through endovascular means (3 cases) or direct surgical ligation (1 case). Neurological examinations were unchanged after arterial repair with only 1 small asymptomatic stroke. Literature review identified 7336 patients, of which there were 25 arterial injuries, of which 19 were of the ICA. Hence, the total rate of arterial injury was 0.34% and the rate of ICA injury was 0.26%. Arterial sacrifice was the only reliable method for managing arterial injury. CONCLUSION Arterial injury is an uncommon event after endoscopic endonasal surgery. Attempts at arterial repair are rarely successful, and vessel sacrifice is the most reliable technique at this point.
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Affiliation(s)
- Alicia Del Carmen Becerra Romero
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.,Department of Neurosurgery and Skull Base Surgery, Hospital Ernesto Dornelles, Porto Alegre, Brazil
| | - Jagath Lal Gangadharan
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Evan D Bander
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Yves Pierre Gobin
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.,Department of Neuroscience, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.,Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Vijay K Anand
- Department of Otolaryngology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.,Department of Neuroscience, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.,Department of Otolaryngology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
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Postoperative CSF leakages after transsphenoidal surgery for pituitary adenomas: Analysis of a series of 302 surgical procedures. Neurocirugia (Astur) 2019; 30:215-221. [PMID: 31130305 DOI: 10.1016/j.neucir.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 02/17/2019] [Accepted: 03/14/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Transsphenoidal surgical removal is the preferred treatment of most pituitary adenomas. Postoperative cerebrospinal fluid (CSF) leakage is the leading cause of morbidity after this procedure, with an incidence rate that varies from 0,5-15% in the main published series. OBJECTIVES The primary objective of this study was to establish the incidence of postoperative CSF leakage in a sample of surgeries performed at the University Hospital of La Ribera by the same surgical team. The secondary objectives were to: ascertain the distinctive features between patients with and without postoperative CSF leakage, identify risk factors for their development, evaluate the relationship between the surgical technique for closing the sella turcica and the onset of postoperative CSF leakage and evaluate different treatment regimens for this complication. METHODS The data of 302 consecutive transsphenoidal surgical procedures for pituitary adenoma removal which were performed between 1999 and 2017 were retrospectively reviewed. RESULTS AND CONCLUSIONS The incidence of postoperative CSF leakage in our series was 2,3% (in accordance with similar published studies). It was possible to correlate intraoperative CSF leakage with two variables: pituitary macroadenoma and tumors with suprasellar extension (P<.005). This correlation did not exist for postoperative CSF leakage. We found a statistically significant correlation between intraoperative and postoperative CSF leakage (P<.005). Due to the low incidence of postoperative CSF leakage in our series, it was not possible to identify risk factors for its development.
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Pak Y, Yang X, Kim Y, Jong C, Kim H, Lee N, Kim S, Kim Y. A study on sublabial transsphenoidal treatment of pituitary tumor under microscope with aid of endoscope. Chin Neurosurg J 2018; 4:22. [PMID: 32922883 PMCID: PMC7398249 DOI: 10.1186/s41016-018-0130-y] [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: 04/09/2018] [Accepted: 07/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background A pituitary tumor is a tumor with a high incidence among brain tumors. Microscopic traditional STT approach with aid of endoscope has a high therapeutic effect and few complications. Methods The authors reviewed 146 patients who underwent STT resection of sellar masses between January 1, 2006, and December 31, 2013. From this group, 40 patients who underwent microscopic STT surgery with aid of endoscope were included in the study. In this series, there were many nonfunctional and Growth Hormone(GH) secreting adenoma. In the study group, tumor size ranged from 60 to 79 mm in 3 cases. Pathophysiological studies, tumor sizes, clinical outcomes, extent of resection, visual function and complication were estimated. Results In our study, gross-total resection(GTR) was achieved in 33 patients (82.5%), subtotal in 3 (7.5%), and partial in 4 (10%). Visual acuity were improved in 82.1%, while 17.9% were unchanged. Visual fields were improved in 81.2%. No deaths occurred in this cohort of patients. Conclusions Pituitary adenoma surgery under microscope with aid of endoscope is an effective treatment method, which results in high (> 90%) rates of resection. It is not associated with high rates of major complications and is safe when performed by experienced surgeons.
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Affiliation(s)
- Yunchol Pak
- Department of Neurosurgery, Pyongyang Medical School Hospital, Kim Il Sung General University, Pyongyang, Democratic People's Republic of Korea
| | - Xuejun Yang
- Department of Neurosurgery, General Hospital, Tianjin Medical University, Tianjin, China
| | - Yongdok Kim
- Department of Neurosurgery, Pyongyang Medical School Hospital, Kim Il Sung General University, Pyongyang, Democratic People's Republic of Korea
| | - Chanhong Jong
- Department of Neurosurgery, Pyongyang Medical School Hospital, Kim Il Sung General University, Pyongyang, Democratic People's Republic of Korea
| | - Haksong Kim
- Department of Neurosurgery, Pyongyang Medical School Hospital, Kim Il Sung General University, Pyongyang, Democratic People's Republic of Korea
| | - Namhyok Lee
- Department of Neurosurgery, Pyongyang Medical School Hospital, Kim Il Sung General University, Pyongyang, Democratic People's Republic of Korea
| | - Songgun Kim
- Department of Neurosurgery, Pyongyang Medical School Hospital, Kim Il Sung General University, Pyongyang, Democratic People's Republic of Korea
| | - Yongchol Kim
- Department of Neurosurgery, Pyongyang Medical School Hospital, Kim Il Sung General University, Pyongyang, Democratic People's Republic of Korea
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Zhang C, Ding X, Lu Y, Hu L, Hu G. Cerebrospinal fluid rhinorrhoea following transsphenoidal surgery for pituitary adenoma: experience in a Chinese centre. ACTA OTORHINOLARYNGOLOGICA ITALICA 2018; 37:303-307. [PMID: 28872159 PMCID: PMC5584102 DOI: 10.14639/0392-100x-1086] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 09/21/2016] [Indexed: 11/23/2022]
Abstract
The aim of this study was to elucidate the risk factors for cerebrospinal fluid (CSF) rhinorrhoea following transsphenoidal surgery and discuss its prevention and treatments. We retrospectively reviewed 474 consecutive cases of pituitary adenoma treated with 485 transsphenoidal surgical procedures from January 2008 to December 2011 in our department. We analysed the incidence of intra- and post-operative CSF leakage and outcomes of various repair strategies. Intra-operative CSF leakage was encountered in 85 cases (17.9%), and post-operative CSF rhinorrhoea in 13 cases (2.7%). Seven of the 13 patients with post-operative CSF rhinorrhoea did not experience intra-operative CSF leakage; three of these patients had adrenocorticotropic hormone-secreting adenomas. Of the remaining 6 patients with both intra- and post-operative CSF leakage, 2 were treated for giant invasive prolactinomas, and 2 had previously undergone transsphenoidal surgery. In eight patients, the leak was resolved by lumbar puncture, lumbar external drainage, resting in a semi-reclining position, or other conservative treatment. Two CSF leaks were repaired with gelatine foam and fibrin glue using a transsphenoidal approach, and two with autologous fat graft and sellar floor reconstruction using a transnasal endoscopic approach. After undergoing two transnasal endoscopic repairs, one patient with post-operative CSF rhinorrhoea was successfully treated by further lumbar subarachnoid drainage. In conclusion, procedures using gelatine foam, fibrin glue and autologous fat graft are common and effective techniques for the management of CSF rhinorrhoea after transsphenoidal surgery. When a CSF leak is detected during transsphenoidal surgery, thorough sellar reconstruction and long-term follow-up are necessary.
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Affiliation(s)
- C Zhang
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Department of Pediatric Neurosurgery, Xinahua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - X Ding
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Y Lu
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - L Hu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - G Hu
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Cong Z, Liu K, Wen G, Qiao L, Wang H, Ma C. Universal Sellar Anatomical Reconstruction Using the Sellar Floor Flap after Endoscopic Pituitary Adenoma Surgery. Otolaryngol Head Neck Surg 2018; 158:774-776. [PMID: 29436283 DOI: 10.1177/0194599818756861] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postoperative cerebrospinal fluid (CSF) leaks still occur in patients without intraoperative CSF leaks after endoscopic endonasal pituitary adenoma surgery. We propose a reconstructive technique, the sellar floor flap (SFF), for universal sellar anatomical reconstruction. A total of 113 patients without intraoperative CSF leaks after endoscopic endonasal pituitary adenoma surgery from July 2013 to June 2016 were reviewed: 43 underwent sellar reconstruction with the SFF (the SFF group) and 70 underwent sellar packing only (the nonreconstruction group). No case of postoperative CSF leak was reported in the SFF group, whereas 7 cases were reported in the nonreconstruction group ( P < .05). The SFF is suitable for universal reconstruction after endoscopic endonasal pituitary adenoma surgery and may decrease postoperative CSF leak.
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Affiliation(s)
- Zixiang Cong
- 1 Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Kaidong Liu
- 1 Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Guodao Wen
- 1 Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Liang Qiao
- 1 Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Handong Wang
- 1 Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
| | - Chiyuan Ma
- 1 Department of Neurosurgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, Jiangsu Province, China
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Fujimoto Y, Balsalobre L, Santos FP, Vellutini E, Stamm AC. Endoscopic combined "transseptal/transnasal" approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases. ARQUIVOS DE NEURO-PSIQUIATRIA 2015. [PMID: 26200057 DOI: 10.1590/0004-282x20150070] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to describe the endoscopic combined "transseptal/transnasal" approach with a pedicled nasoseptal flap for pituitary adenoma and skull base reconstruction, especially with respect to cerebrospinal fluid (CSF) fistula. METHOD Ninety-one consecutive patients with pituitary adenomas were retrospectively reviewed. All patients underwent the endoscopic combined "transseptal/transnasal" approach by the single team including the otorhinolaryngologists and neurosurgeons. Postoperative complications related to the flap were analyzed. RESULTS Intra- and postoperative CSF fistulae were observed in 36 (40%) and 4 (4.4%) patients, respectively. Among the 4 patients, lumbar drainage and bed rest healed the CSF fistula in 3 patients and reoperation for revision was necessary in one patient. Other flap-related complications included nasal bleeding in 3 patients (3.3%). CONCLUSION The endoscopic combined "transseptal/transnasal" approach is most suitable for a two-surgeon technique and a pedicled nasoseptal flap is a reliable technique for preventing postoperative CSF fistula in pituitary surgery.
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Affiliation(s)
- Yasunori Fujimoto
- Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
| | - Leonardo Balsalobre
- São Paulo ENT Center, Complexo Hospitalar Edmundo Vasconcelos, Sao Paulo, SP, Brazil
| | - Fábio P Santos
- São Paulo ENT Center, Complexo Hospitalar Edmundo Vasconcelos, Sao Paulo, SP, Brazil
| | | | - Aldo C Stamm
- São Paulo ENT Center, Complexo Hospitalar Edmundo Vasconcelos, Sao Paulo, SP, Brazil
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Sanders-Taylor C, Anaizi A, Kosty J, Zimmer LA, Theodosopoulos PV. Sellar Reconstruction and Rates of Delayed Cerebrospinal Fluid Leak after Endoscopic Pituitary Surgery. J Neurol Surg B Skull Base 2015. [PMID: 26225317 DOI: 10.1055/s-0034-1544118] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objectives Delayed cerebrospinal fluid (CSF) leaks are a complication in transsphenoidal surgery, potentially causing morbidity and longer hospital stays. Sella reconstruction can limit this complication, but is it necessary in all patients? Design Retrospective review. Setting Single-surgeon team (2005-2012) addresses this trend toward graded reconstruction. Participants A total of 264 consecutive patients with pituitary adenomas underwent endoscopic transsphenoidal resections. Sellar defects sizable to accommodate a fat graft were reconstructed. Main outcomes Delayed CSF leak and autograft harvesting. Results Overall, 235 (89%) had reconstruction with autograft (abdominal fat, septal bone/cartilage) and biological glue. Delayed CSF leak was 1.9%: 1.7%, and 3.4% for reconstructed and nonreconstructed sellar defects, respectively (p = 0.44). Complications included one reoperation for leak, two developed meningitis, and autograft harvesting resulted in abdominal hematoma in 0.9% and wound infection in 0.4%. Conclusion In our patients, delayed CSF leaks likely resulted from missed intraoperative CSF leaks or postoperative changes. Universal sellar reconstruction can preemptively treat missed leaks and provide a barrier for postoperative changes. When delayed CSF leaks occurred, sellar reconstruction often allowed for conservative treatment (i.e., lumbar drain) without repeat surgery. We found universal reconstruction provides a low risk of delayed CSF leak with minimal complications.
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Affiliation(s)
- Chris Sanders-Taylor
- Department of Neurosurgery, University of Cincinnati College of Medicine; Brain Tumor Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio, United States
| | - Amjad Anaizi
- Department of Neurosurgery, University of Cincinnati College of Medicine; Brain Tumor Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio, United States
| | - Jennifer Kosty
- Department of Neurosurgery, University of Cincinnati College of Medicine; Brain Tumor Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio, United States
| | - Lee A Zimmer
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine; Brain Tumor Center at UC Neuroscience Institute, Mayfield Clinic, Cincinnati, Ohio, United States
| | - Phillip V Theodosopoulos
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States
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Yadav Y, Sachdev S, Parihar V, Namdev H, Bhatele P. Endoscopic endonasal trans-sphenoid surgery of pituitary adenoma. J Neurosci Rural Pract 2012. [PMID: 23188987 PMCID: PMC3505326 DOI: 10.4103/0976-3147.102615] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Endoscopic endonasal trans-sphenoid surgery (EETS) is increasingly used for pituitary lesions. Pre-operative CT and MRI scans and peroperative endoscopic visualization can provide useful anatomical information. EETS is indicated in sellar, suprasellar, intraventricular, retro-infundibular, and invasive tumors. Recurrent and residual lesions, pituitary apoplexy and empty sella syndrome can be managed by EETS. Modern neuronavigation techniques, ultrasonic aspirators, ultrasonic bone curette can add to the safety. The binostril approach provides a wider working area. High definition camera is much superior to three-chip camera. Most of the recent reports favor EETS in terms of safety, quality of life and tumor resection, hospital stay, better endocrinological, and visual outcome as compared to the microscopic technique. Nasal symptoms, blood loss, operating time are less in EETS. Various naso-septal flaps and other techniques of CSF leak repair could help reduce complications. Complications can be further reduced after achieving the learning curve, good understanding of limitations with proper patient selection. Use of neuronavigation, proper post-operative care of endocrine function, establishing pituitary center of excellence and more focused residency and endoscopic fellowship training could improve results. The faster and safe transition from microscopic to EETS can be done by the team concept of neurosurgeon/otolaryngologist, attending hands on cadaveric dissection, practice on models, and observation of live surgeries. Conversion to a microscopic or endoscopic-assisted approach may be required in selected patients. Multi-modality treatment could be required in giant and invasive tumors. EETS appears to be a better surgical option in most pituitary adenoma.
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Affiliation(s)
- Yr Yadav
- Department of Neurosurgery and Radiodiagnosis NSCB Medical College and MP MRI Jabalpur, Madhya Pradesh, India
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