Endonasal transsphenoidal surgery: the patient's perspective—survey results from 259 patients

Dusick, Joshua R.; Esposito, Felice; Mattozo, Carlos Alberto; Chaloner, Charlene; McArthur, David L.; Kelly, Daniel F.

doi:10.1016/j.surneu.2005.12.010

Cited by 105 publications

(78 citation statements)

References 30 publications

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“…Accordingly, several authors have reported on the addition of an endoscope to augment visualization of remaining tumor during microscopic resections. 12,18 In a series of 800 patients, Fatemi et al 21 examined the benefits and limitations of the microscopic endonasal approach to the sella and reported little difficulty with removal of standard microadenomas, but encountered formidable challenges when attempting to remove larger suprasellar nonadenomatous lesions. Studies report rates of GTR after microscopic transsphenoidal surgery that range from 6.9 to 90%.…”

Section: Discussionmentioning

confidence: 99%

Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas

Campbell¹,

McGettigan

Luginbuhl

et al. 2010

FOC

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Object The expanded endoscopic approach to craniopharyngiomas has recently been described in several small case series. The authors present their experience with this technique and review the available literature. Methods Between September 2006 and September 2009, 14 patients underwent a purely endoscopic, endonasal approach for resection of newly diagnosed craniopharyngiomas. These procedures represent index surgeries; no patient had undergone previous tumor resection. A retrospective review of endocrinological and ophthalmological outcomes, extent of resection, and complication prevalence was completed. Additionally, a review of the English literature was performed to evaluate outcomes of similar endoscopic techniques for resection of craniopharyngiomas. Results Four patients (28.6%) underwent gross-total resection; near total resection or better was achieved in 9 patients (64.3%). All patients presented with some form of visual field or acuity deficit. Postoperatively, 12 patients (85.7%) experienced visual improvement, with 6 patients (42.9%) having complete visual recovery. One patient experienced worsening of her visual deficit. Visual acuity improved in 8 patients ((57.1%), while visual field defects improved in 11 (78.6%). The pituitary stalk was preserved in all cases. Eight (57.1%) of 14 patients experienced some form of anterior pituitary dysfunction postoperatively. Although 9 patients (64.3%) were documented to have either transient or permanent new diabetes insipidus immediately after surgery, at 1-month follow-up only 1 patient met clinical criteria. Five patients (35.7%) developed CSF leaks that were successfully treated by subsequent endoscopic revision. All CSF leaks occurred early in the series. Two patients (14.2%) were treated for presumed meningitis postoperatively. Conclusions The endoscopic endonasal approach is a minimally invasive alternative to open transcranial approaches for select craniopharyngiomas. Similar to previous transcranial series, rates of endocrinopathy and gross-total resection were dependent upon the adherence of the tumor capsule to the hypothalamus, pituitary stalk, and associated vasculature. A review of the literature suggests that the results of the current series are similar to other published series on this topic.

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Section: Discussionmentioning

confidence: 99%

Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas

Campbell¹,

McGettigan

Luginbuhl

et al. 2010

FOC

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“…2,9,16,19 Moreover, the endoscopic approach is also claimed to be associated with fewer nasal complications compared with microscopic transsphenoidal approaches. 2,19 Localized nasal complications such as obstruction and crusting have been reported in up to 38% of microscopic transsphenoidal surgeries.…”

Section: Suresmentioning

confidence: 99%

“…9, 16 Dusick et al 9 provided the only other quantitative assessment of the success of microscopic endonasal transsphenoidal surgery from the patients' perspective. They reported that by 3 months after microscopic transsphenoidal surgery, 67%-87% of patients had no rhinological complaints and concluded that rhinological recovery is rapid and relatively complete following microscopic endonasal transsphenoidal surgery.…”

Section: Suresmentioning

confidence: 99%

Nasal symptoms following endoscopic transsphenoidal pituitary surgery: assessment using the General Nasal Patient Inventory

Wang¹,

Srirathan²,

Tirr³

et al. 2011

FOC

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Object The endoscopic approach for pituitary tumors is a recent innovation and is said to reduce the nasal trauma associated with transnasal transsphenoidal surgery. The authors assessed the temporal changes in the rhinological symptoms following endoscopic transsphenoidal surgery for pituitary lesions, using the General Nasal Patient Inventory (GNPI). Methods The GNPI was administered to 88 consecutive patients undergoing endoscopic transsphenoidal surgery at 3 time points (presurgery, 3–6 months postsurgery, and at final follow-up). The total GNPI score and the scores for the individual GNPI questions were calculated and differences between groups were assessed once before surgery, several months after surgery, and at final follow-up. Results Of a maximum possible score of 135, the mean GNPI score at 3–6 months postsurgery was only 12.9 ± 12 and was not significantly different from the preoperative score (10.4 ± 13) or final follow-up score (10.3 ± 10). Patients with functioning tumors had higher GNPI scores than those with nonfunctioning tumors for each of these time points (p < 0.05). Individually, a mild increase in symptom severity was seen for symptoms attributable to the nasal trauma of surgery, with partial recovery (nasal sores and bleeding) or complete recovery (nasal blockage, painful sinuses, and unpleasant nasal smell) by final follow-up (p < 0.05). Progressive improvements in symptom severity were seen for symptoms more attributable to tumor mass preoperatively (for example, headaches and painkiller use [p < 0.05]). In total, by final follow-up 8 patients (9%) required further treatment or advice for ongoing nasal symptoms. Conclusions Endoscopic transsphenoidal surgery is a well-tolerated minimally invasive procedure for pituitary fossa lesions. Overall patient-assessed nasal symptoms do not change, but some individual symptoms may show a mild worsening or overall improvement.

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“…Based on this guideline, all of the patients in this study would have undergone surgery even though five of six patients lacked visual deterioration at initial presentation. Given the previously mentioned studies that report the resilience of the chiasm against deformation, this proposed indicator may actually engender premature exposure to surgery and the accompanying potential peri-operative complications [15][16][17] .…”

Section: Discussionmentioning

confidence: 98%

Conservative Management of Pituitary Macroadenoma Contacting the Optic Apparatus

Ryu

Tam

Rotenberg

et al. 2010

Can. j. neurol. sci.

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Non-functioning pituitary macroadenoma (NFMA) is the most prevalent type of pituitary tumor, accounting for approximately 15% of all pituitary tumors. Even with such prevalence, current understanding of the natural history of nonfunctioning pituitary macroadenoma remains controversial 1,2 . Two publications on conservatively managed NFMA are limited by heterogeneous patient cohort (e.g. combining macro and microadenomas), and a small number of patients with actual visual pathway involvement (e.g. contact with optic chiasm, optic nerve, or optic tract). Karavitaki et al (2007) studied the natural history of 40 patients with non-functioning pituitary adenomas, of which 16 were microadenoma and do not distinguish the number of macroadenoma cases with actual chiasm compression 3 . The only information regarding mass effect was that three patients had developed new chiasm involvement and, in these patients, surgical decompression was carried out. Similarly, Dekker et al (2007) examined 28 nonsurgical NFMA patients but only 2/28 patients were noted to have compression of the chiasm 4 . ABSTRACT: Objectives:To describe the tumor characteristics and visual function in conservatively managed patients with nonfunctioning pituitary macroadenoma (NFMA) that contacted/compressed the visual pathway. Design: Retrospective case-series. Setting: Tertiary-care academic institution. Participants: Six patients with diagnosis of NFMA. Main Outcome: Visual function and radiological characteristics of the optic apparatus and pituitary tumor. Results: All patients had radiological evidence of optic apparatus compression but only one had visual field defect at the initial presentation. While two of the six patients developed visual field changes during followup (41±34.8 months), the patient with visual field defect at the time of diagnosis improved to normal vision. Conclusions: Select NFMAs that contact the optic apparatus, without visual dysfunction, may be managed with close ophthalmological and radiographic monitoring, depending on tumor and imaging characteristics. This may be of particular relevance in patients considered to have a high peri-operative risk, such as advanced age or significant co-morbidities.RÉSUMÉ: Traitement conservateur des macro adénomes pituitaires en contact avec l'appareil optique. Objectifs : Le but de l'étude était de décrire les caractéristiques des tumeurs et la fonction visuelle chez les patients atteints de macro adénomes pituitaires non fonctionnels (MANF) adjacents ou comprimant les voies optiques, traités de façon conservatrice. Méthodologie : Il s'agit d'une étude rétrospective portant sur six patients ayant consulté dans une institution académique de soins tertiaires, chez qui un diagnostic de MANF a été posé. L'issue primaire était la fonction visuelle et les caractéristiques radiologiques de l'appareil optique et de la tumeur pituitaire. Résultats : Tous les patients avaient une compression de l'appareil optique à l'imagerie, mais seulement un avait un déficit du champ visuel au moment de la pre...

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Endonasal transsphenoidal surgery: the patient's perspective—survey results from 259 patients

Cited by 105 publications

References 30 publications

Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas

Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas

Nasal symptoms following endoscopic transsphenoidal pituitary surgery: assessment using the General Nasal Patient Inventory

Conservative Management of Pituitary Macroadenoma Contacting the Optic Apparatus

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