Endoscopic Endonasal Transsphenoidal Approach to Pituitary Adenoma: A Multi-disciplinary Approach

Regmi, Deepak; Thapa, Amit; Kc, Bidur; Shakya, Bikram

doi:10.3126/jnhrc.v15i2.18209

Cited by 8 publications

(11 citation statements)

References 15 publications

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“…Endoscopic visualization provides a more panoramic view of the operative field, compared with the microscope, allowing for better viewing of the suprasellar region ( 51 , 52 ). It is also possible to use instruments with a variety of angles to access lateral invasions of tumors ( 12 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Qiao

2018

Endocrine Connections

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IntroductionIt is unclear whether the proportions of remission and the recurrence rates differ between endoscopic transsphenoidal surgery (TS) and microscopic TS in Cushing’s disease (CD); thus, we conducted a systematic review and meta-analysis to evaluate studies of endoscopic TS and microscopic TS.MethodsWe conducted a comprehensive search of PubMed to identify relevant studies. Remission and recurrence were used as outcome measures following surgical treatment of CD.ResultsA total of 24 cohort studies involving 1670 adult patients were included in the comparison. Among these studies, 702 patients across 9 studies underwent endoscopic TS, and 968 patients across 15 studies underwent microscopic TS. Similar baseline characteristics were observed in both groups. There was no significant difference in remission between the two groups: 79.7% (95% CI: 73.1–85.0%) in the endoscopic group and 76.9% (95% CI: 71.3–81.6%) in the microscopic group (P = 0.485). It appears that patients who underwent endoscopic surgery experience recurrence less often than patients who underwent microscopic surgery, with recurrence proportions of 11.0% and 15.9%, respectively (P = 0.134). However, if follow-up time is taken into account, both groups had a recurrence rate of approximately 4% per person per year (95% CI: 3.1–5.4% and 3.6–5.1%, P = 0.651).ConclusionsWe found that remission proportion and recurrence rate were the same in patients who underwent endoscopic TS as in patients who underwent microscopic TS. The definition of diagnosis, remission and recurrence should always be considered in the studies assessing therapeutic efficacy in CD.

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Section: Discussionmentioning

confidence: 99%

Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Qiao

2018

Endocrine Connections

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“…For example, Gardner et al performed balloon occlusion in a tumor surrounding the ICA (18). If the test occlusion fails in the patient, care should be taken not to injure the ICA during surgery (19). The limitation of the case is no stent available at that time where an endovascular balloon was applied to occlude the left ICA.…”

Section: Discussionmentioning

confidence: 99%

Internal carotid artery injury in the endoscopic transsphenoidal surgery for pituitary adenoma: an uncommon case and literature review

Liu¹,

Feng²,

Dai³

et al. 2020

Gland Surg

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Complications of the transsphenoidal surgery (TSS) for pituitary adenoma (PA) include vascular injury, nerve injury and nervous system infection. Among these, the consequences of internal carotid artery (ICA) injury are the most serious, and its mortality and disability rates are very high. The TSS was used in 889 patients with PA, among which there was 1 case of ICA injury. In this uncommon case of bromocirptineresistant macro-prolatinoma, the patient had received an ultrahigh dose of oral bromocriptine for almost three years and was intraoperatively found to have a tenacious tumor texture and close adhesion of the tumor capsule to the ICA. Resection of the tumor capsule required excessive force, resulting in the rupture at the A1 origin of the left ICA. Endovascular balloon occlusion was used after urgent angiography. The patient died in two weeks even with intensive treatment. Although the underlying mechanism is still obscure, bromocriptine-inducing tumor fibrosis in PA is relatively common. For these patients with excessive dose of bromocriptine, tumor fibrosis and ICA injury should be seriously considered and performing a complete preoperative imaging evaluation to achieve accurate intraoperative positioning and carefully performing the operation are needed to preventing ICA injury. In some cases, resection of the tumor pseudocapsule should not be forced to avoid ICA injury.

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“…The two-hand technique, utilizing a one-and-a-half nostril approach, offers more refined manipulation. Notably, the two-hand/one-and-a-half nostril technique in single-surgeon endoscopic endonasal transsphenoidal surgery has been shown to be safe and effective for excising large pituitary tumors [80,81].…”

Section: The Exceptions: Pituitary Adenomas and The Alternative Treat...mentioning

confidence: 99%

From Genes to Therapy: Pituitary Adenomas in the Era of Precision Medicine

Toader,

Dobrin,

Tataru

et al. 2023

Biomedicines

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This review presents a comprehensive analysis of pituitary adenomas, a type of brain tumor with diverse behaviors and complexities. We cover various treatment approaches, including surgery, radiotherapy, chemotherapy, and their integration with newer treatments. Key to the discussion is the role of biomarkers in oncology for risk assessment, diagnosis, prognosis, and the monitoring of pituitary adenomas. We highlight advances in genomic, epigenomic, and transcriptomic analyses and their contributions to understanding the pathogenesis and molecular pathology of these tumors. Special attention is given to the molecular mechanisms, including the impact of epigenetic factors like histone modifications, DNA methylation, and transcriptomic changes on different subtypes of pituitary adenomas. The importance of the tumor immune microenvironment in tumor behavior and treatment response is thoroughly analyzed. We highlight potential breakthroughs and innovations for a more effective management and treatment of pituitary adenomas, while shedding light on the ongoing need for research and development in this field to translate scientific knowledge into clinical advancements, aiming to improve patient outcomes.

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Endoscopic Endonasal Transsphenoidal Approach to Pituitary Adenoma: A Multi-disciplinary Approach

Cited by 8 publications

References 15 publications

Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Internal carotid artery injury in the endoscopic transsphenoidal surgery for pituitary adenoma: an uncommon case and literature review

From Genes to Therapy: Pituitary Adenomas in the Era of Precision Medicine

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