Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas

Hofstetter, Christoph P.; Shin, Benjamin J.; Mubita, Lynn; Huang, Clark; Anand, Vijay K.; Boockvar, John A.; Schwartz, Theodore H.

doi:10.3171/2011.1.focus10317

Cited by 115 publications

(88 citation statements)

References 44 publications

(66 reference statements)

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“…Series confirming that the operations were carried out by one or two surgeons in a single center or by surgeons each performing 80 pituitary operations per year mostly show higher remission rates (82 -100%) (13,14,15,16,18,20,30,31,32) pointing out the importance of surgical expertise. Other factors affecting biochemical remission are not clearly defined specifically for the microprolactinomas as the reported results include analyses for both micro-and macroprolactinomas.…”

Section: Transsphenoidal Surgery For Microprolactinomasmentioning

confidence: 89%

“…Series reporting the outcomes of endoscopic transsphenoidal surgery in microprolactinomas are rather limited ( Table 2). The postoperative remission rates range between 81 and 100%, and in all but one of the studies, there is no available information on previous DA administration (19,28,29,30,31,32,33,34,35). Given that the main advantages of the endoscopic approach involve invasive adenomas, it would be anticipated that the remission rates should not differ between microscopic and endoscopic techniques in microprolactinomas.…”

Section: Transsphenoidal Surgery For Microprolactinomasmentioning

confidence: 99%

“…The reported peri-and postoperative complications in endoscopic series include mortality 0% (19,29,30,31,33,34,35,37), visual deterioration 0% (32,34,37), and other neurosurgical complications 0% (37). The outcomes of pituitary function are given in Table 3; new pituitary hormone deficits range between 0 and 6% (19,29,30,37).…”

Section: Peri-and Post-operative Complications In Microprolactinomasmentioning

confidence: 99%

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THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature

Tampourlou

Trifănescu

Paluzzi³

et al. 2016

European Journal of Endocrinology

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Microprolactinomas are the most common pituitary adenomas. In symptomatic patients, dopamine agonists are the first-line treatment of choice; when cabergoline is used, biochemical control rates between 85 and 93% have been reported. Long-term treatment is needed in most of the cases with compliance, patient convenience, and potential adverse effects representing areas requiring attention. Based on the literature published in the past 15 years, transsphenoidal surgery can lead to normal prolactin in the postoperative period in usually 71 -100% of the cases with very low postoperative complication rates. Surgical expertise is the major determinant of the outcomes, and it may be a cost-effective option in young patients with life expectancy greater than 10 years (provided it is performed by experienced surgeons at high volume centers with confirmed optimal outcomes). Larger series of patients with adequate follow-up could further validate the place of transsphenoidal surgery (particularly through the endoscopic approach for which long-term results are currently limited) in the management algorithm of patients with microprolactinoma. 175:3R89-R96 M Tampourlou and others Surgery for microprolactinomas

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Section: Transsphenoidal Surgery For Microprolactinomasmentioning

confidence: 89%

Section: Transsphenoidal Surgery For Microprolactinomasmentioning

confidence: 99%

Section: Peri-and Post-operative Complications In Microprolactinomasmentioning

confidence: 99%

See 1 more Smart Citation

THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature

Tampourlou

Trifănescu

Paluzzi³

et al. 2016

European Journal of Endocrinology

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“…Detailed descriptions of the surgical technique are provided in our previous articles. 7,9,11,12,30 For statistical power, we divided the approaches into 4 subtypes: 1) transsellar; 2) transplanum; 3) transcribriform, transpterygoid, or transethmoidal; and 4) transcavernous and transclival.…”

Section: Operative Technique and Closure Methodsmentioning

confidence: 99%

Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks

Banu

Szentirmai

Mascarenhas

et al. 2014

JNS

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Object Postoperative pneumocephalus is a common occurrence after endoscopic endonasal skull base surgery (ESBS). The risk of cerebrospinal fluid (CSF) leaks can be high and the presence of postoperative pneumocephalus associated with serosanguineous nasal drainage may raise suspicion for a CSF leak. The authors hypothesized that specific patterns of pneumocephalus on postoperative imaging could be predictive of CSF leaks. Identification of these patterns could guide the postoperative management of patients undergoing ESBS. Methods The authors queried a prospectively acquired database of 526 consecutive ESBS cases at a single center between December 1, 2003, and May 31, 2012, and identified 258 patients with an intraoperative CSF leak documented using intrathecal fluorescein. Postoperative CT and MRI scans obtained within 1–10 days were examined and pneumocephalus was graded based on location and amount. A discrete 0–4 scale was used to classify pneumocephalus patterns based on size and morphology. Pneumocephalus was correlated with the surgical approach, histopathological diagnosis, and presence of a postoperative CSF leak. Results The mean follow-up duration was 56.7 months. Of the 258 patients, 102 (39.5%) demonstrated pneumocephalus on postoperative imaging. The most frequent location of pneumocephalus was frontal (73 [71.5%] of 102), intraventricular (34 [33.3%]), and convexity (22 [21.6%]). Patients with craniopharyngioma (27 [87%] of 31) and meningioma (23 [68%] of 34) had the highest incidence of postoperative pneumocephalus compared with patients with pituitary adenomas (29 [20.6%] of 141) (p < 0.0001). The incidence of pneumocephalus was higher with transcribriform and transethmoidal approaches (8 of [73%] 11) than with a transsellar approach (9 of [7%] 131). There were 15 (5.8%) of 258 cases of postoperative CSF leak, of which 10 (66.7%) had pneumocephalus, compared with 92 (38%) of 243 patients without a postoperative CSF leak (OR 3.3, p = 0.027). Pneumocephalus located in the convexity, interhemispheric fissure, sellar region, parasellar region, and perimesencephalic region was significantly correlated with a postoperative CSF leak (OR 4.9, p = 0.006) and was therefore termed “suspicious” pneumocephalus. In contrast, frontal or intraventricular pneumocephalus was not correlated with postoperative CSF leak (not significant) and was defined as “benign” pneumocephalus. The amount of convexity pneumocephalus (p = 0.002), interhemispheric pneumocephalus (p = 0.005), and parasellar pneumocephalus (p = 0.007) (determined using a scale score of 0–4) was also significantly related to postoperative CSF leaks. Using a series of permutation-based multivariate analyses, the authors established that a model containing the learning curve, the transclival/transcavernous approach, and the presence of “suspicious” pneumocephalus provides the best overall prediction for postoperative CSF leaks. Conclusions Postoperative pneumocephalus is much more common following extended approaches than following transsellar surgery. Merely the presence of pneumocephalus, particularly in the frontal or intraventricular locations, is not necessarily associated with a postoperative CSF leak. A “suspicious” pattern of air, namely pneumocephalus in the convexity, interhemispheric fissure, sella, parasellar, or perimesencephalic locations, is significantly associated with a postoperative CSF leak. The presence and the score of “suspicious” pneumocephalus on postoperative imaging, in conjunction with the learning curve and the type of endoscopic approach, provide the best predictive model for postoperative CSF leaks.

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“…Using a fully endoscopic approach for patients with acromegaly, Jane et al [ 65 ] achieved a remission rate of 100% for GH-secreting microadenomas and 61% for macroadenomas. Hofstetter et al [ 59 ] analyzed remission rates for all types of functional adenomas treated by an endoscopic approach. Rates were 92.3% (microadenomas) and 57.1% (macroadenomas) for prolactin-secreting tumors, 75% (microadenomas) and 40% (macroadenomas) for GH-secreting tumors and 54.5% (microadenomas) and 71.4% (macroadenomas) for adrenocorticotropic hormonesecreting tumors.…”

Section: Pituitary Adenomasmentioning

confidence: 99%

Transsphenoidal endoscopic skull base surgery: state of the art and future perspective

Cutler

Barkhoudarian

Griffiths³

et al. 2013

Innovative Neurosurgery

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Given refinements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques and anatomical understanding, the endonasal endoscopic approach is now a well-accepted and widely utilized technique for removal of many if not most midline ventral skull base tumors. Pituitary adenomas and Rathke ' s cleft cysts (RCCs) constitute the majority of lesions removed via this route; however, craniopharyngiomas, clival chordomas, midline meningiomas and other benign and malignant skull base tumors are now increasingly removed by this approach. Herein we describe the evolution of the endonasal endoscopic technique, its current use for sellar and midline skull base tumors and potential for future innovation.

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Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas

Cited by 115 publications

References 44 publications

THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature

THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature

Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks

Transsphenoidal endoscopic skull base surgery: state of the art and future perspective

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