Endoscopic endonasal transsphenoidal approach for pituitary adenomas: technical aspects and report of casuistic

Santos, Américo Rubens Leite dos; Neto, Roberto Monteiro Fonseca; Veiga, José Carlos Esteves; Viana, José E.; Scaliassi, Nilza Maria; Lancellotti, Carmen Lúcia Penteado; Lazarini, Paulo Roberto

doi:10.1590/s0004-282x2010000400024

Cited by 31 publications

(37 citation statements)

References 23 publications

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“…In this study, the postoperative complication rate was 56.5%, including one major complication (ischemic stroke). This result is significantly higher than observed in recent papers 1,3,4,5,11,18,23,28 , probably due to the greater prevalence of macroadenomas with extrasellar extension (65.2%) in our cohort (Figure 1). Large suprasellar and parasellar extensions with invasion of cavernous sinus may add a significant risk of complications to the procedure.…”

Section: Methodscontrasting

confidence: 77%

“…Transient diabetes insipidus occurred in seven patients (30.4%), which is just comparable with the 37.5% rate of Wangenmakers et al 23 ; in others studies this percentage varied from 3.3% to 9.1% 1,3,4,18,28 . Permanent diabetes insipidus occurred in two patients (8.7%), which is a little higher than the 6.7% found by Bunderen et al 11 and our own previous experience 18 .…”

Section: Methodssupporting

confidence: 76%

“…As shown in recent papers, the best results were achieved in microadenomas (56-100%) compared to macroadenomas (27-71.7%) 1,4,18,28 . The worst outcomes were related to suprasellar and parasellar lesions.…”

Section: Methodsmentioning

confidence: 60%

“…All the patients were submitted to an endoscopic endonasal transsphenoidal approach with a technique described in our previous publication 18 . All operations were performed by the same neurosurgeon.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…In 1893, in England, the first pituitary surgery for acromegaly was performed by Caton and Paul, under the supervision of Sir Victor Horsley 11,12,13 , while the first transnasal resection of a pituitary tumor was performed by Schloffer in 1907 14 . Cushing 15 systematically used a transsphenoidal approach in sellar lesions and this technique was subsequently refined and popularized by Guiot 16 and Hardy 17,18 . The objectives of the surgical approach are gross tumor resection, relief of mass effect, normalization of hormone levels, reduction of recurrences and avoidance of postoperative complications, resulting in reduced morbidity and mortality 3,19,20 .…”

mentioning

confidence: 99%

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Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery

Leopoldo¹,

Leopoldo²,

Santos³

et al. 2017

Arq. Neuro-Psiquiatr.

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ABSTRACT.Objective: The aim of this study was to evaluate the results of the endoscopic transsphenoidal technique for growth hormone (GH)-secreting adenomas. Methods: A retrospective analysis based on medical records of 23 acromegalic patients submitted to endoscopic transsphenoidal surgery. Biochemical control was defined as basal GH < 1ng/ml, nadir GH < 0.4ng/ml after glucose load and age-adjusted IGF-1 normal at the last follow-up. Results: The overall endocrinological remission rate was 39.1%. While all microademonas achieved a cure, just one third of macroadenomas went into remission. Suprasellar extension, cavernous sinus invasion and high GH levels were associated with lower rates of disease control. The most common complication was diabetes insipidus and the most severe was an ischemic stroke. Conclusion: The endoscopic transsphenoidal approach is a safe and effective technique to control GH-secreting adenomas. The transcavernous approach may increase the risk of complications. Suprasellar and cavernous sinus extensions may preclude gross total resection of these tumors.Keywords: acromegaly; growth hormone-secreting pituitary adenoma; endoscopy RESUMO Objetivo: O objetivo do estudo é analisar os resultados da cirurgia de ressecção endoscópica transesfenoidal para adenomas secretores do hormônio do crescimento (GH). Métodos: Revisão retrospectiva baseada em análise de prontuários de 23 pacientes acromegálicos submetidos à cirurgia endoscópica. Remissão foi definida por GH < 1ng/ml, nadir de GH ≤ 0,4ng/ml no teste oral de tolerância a glicose e IGF-1 normal para idade. Resultados: A taxa de remissão endocrinológica foi 39,1%. Enquanto todos microadenomas alcançaram controle hormonal, apenas um terço dos macroadenomas obtiveram remissão. Extensão suprasselar, invasão do seio cavernoso e altos níveis de GH foram associados a menores taxas de controle da doença. A complicação mais comum foi diabetes insipidus e a mais grave foi acidente vascular encefálico isquêmico. Conclusão: A abordagem endoscópica transesfenoidal é segura e efetiva para controle de adenomas hipofisários secretores de GH. A abordagem ao seio cavernoso pode aumentar a morbidade da cirurgia. Extensões suprasselares e no seio cavernoso podem dificultar a ressecção completa e o controle da doença.Palavras-chave: acromegalia; adenoma hipofisário secretor de hormônio do crescimento; endoscopia

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Section: Methodscontrasting

confidence: 77%

Section: Methodssupporting

confidence: 76%

Section: Methodsmentioning

confidence: 60%

Section: Surgical Proceduresmentioning

confidence: 99%

mentioning

confidence: 99%

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Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery

Leopoldo¹,

Leopoldo²,

Santos³

et al. 2017

Arq. Neuro-Psiquiatr.

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Spectrophotometric measurements of human tissues for the detection of subjacent blood vessels in an endonasal endoscopic surgical approach

Ernstberger

Boeswetter

Baselt

et al. 2012

Journal of Biophotonics

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Thin slices of human tissues are characterized concerning reflection and transmission in a wavelength range from 400 to 1700 nm. The results are primarily useful to find a wavelength for the detection of subjacent blood vessels during surgical procedures, especially neurological surgery. The measurements have been conducted using a customized measuring station, utilizing two halogen bulb lamps and two spectrometers. This paper focuses on creating a data base with the optical properties of artery, brain, bone, nasal mucosa, and nerve. The spectral distributions are compared among each other, similarities and differences are pointed out. Each tissue has got unique spectral characteristics, whereas typical absorption bands can be found in the overall tissues, especially hemoglobin and water absorption bands. The reflectivity maxima are typically located in the red or near-infrared. All the transmission maxima are located between 1075 nm and 1100 nm. The measurements have been conducted at the Institute of Anatomy at the University of Leipzig.

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Sarcoidosis of the Head and Neck

Badhey

Kadakia

Carrau

et al. 2014

Head and Neck Pathol

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Sarcoidosis is a complex disorder that often times involves the head and neck. Despite the presence of strong clinical evidence, tissue diagnosis and imaging is needed for confirmation of the disease. Although typically managed medically, when found in the sinonasal tract or intracranially, it may necessitate the intervention of a rhinologist-skull base surgeon. This article seeks to provide a comprehensive review of head and neck sarcoidosis, as this fascinating disorder often poses a diagnostic and therapeutic challenge. A brief discussion of surgical treatment for pituitary lesions is also provided. Articles from 1997 to 2013 were selected and reviewed by three researchers utilizing the most recent literature regarding sarcoidosis in the head and neck. PubMed searches were conducted using search terms such as "sarcoidosis", "neurosarcoid", and "extra-pulmonary sarcoid", among many others. A large collection of articles was generated and reviewed by the team of authors, and appropriate information was extracted to compose a thorough and expansive review of the subject. 10-15 % of patients with sarcoidosis have head and neck manifestations. Sinonasal and pituitary sarcoidosis presents a diagnostic challenge owing to its non-specific symptoms. Although systemic steroid therapy is often the first time treatment, endoscopic surgery is commonly used to treat advanced pituitary sarcoidosis refractory to medical management. As tissue diagnosis and imaging is key, a multi-disciplinary team approach is advantageous. Our study collates the available literature on head and neck sarcoidosis to provide a comprehensive review of the subject. This provides helpful information to guide all practitioners involved in the care of these challenging patients, namely pathologists, radiologists, otolaryngologists, and skull base surgeons, in the workup and management of head and neck sarcoidosis.

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Endoscopic endonasal transsphenoidal approach for pituitary adenomas: technical aspects and report of casuistic

Cited by 31 publications

References 23 publications

Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery

Long term follow-up of growth hormone-secreting pituitary adenomas submitted to endoscopic endonasal surgery

Spectrophotometric measurements of human tissues for the detection of subjacent blood vessels in an endonasal endoscopic surgical approach

Sarcoidosis of the Head and Neck

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