Endoscopic endonasal transsphenoidal surgery: predictors for disease control in a consecutive series of pituitary adenomas

Ismail, Mostafa; Abdelhak, Balegh; D’Haens, Jean; Michel, Olaf

doi:10.4103/1012-5574.186523

Cited by 2 publications

(3 citation statements)

References 34 publications

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“…This step is even more critical when there is CSF leak to prevent meningitis. 5 This step passed through a process of development and evolution with a lot of used material and techniques. 4 5 6 7 8 9 10 11 12 13 14 15 16 17 21…”

Section: Discussionmentioning

confidence: 99%

“…5 This step passed through a process of development and evolution with a lot of used material and techniques. 4 5 6 7 8 9 10 11 12 13 14 15 16 17 21…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the presence of sellar packing may interfere with the interpretation of postoperative images.” 1 Therefore, some authors started to reconstruct the sella using absorbable materials, such as gelfoam and/or surgical, only when there is no intraoperative CSF leak. 2 4 5…”

Section: Introductionmentioning

confidence: 99%

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Sellar Floor Reconstruction with and without Intrasellar Fat Packing after Endoscopic Resection of Large Pituitary Macroadenomas with Evident Intraoperative CSF Leak

Darwish

Nanous

Hamead

et al. 2022

Indian Journal of Neurosurgery

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Background Intraoperative cerebrospinal fluid (CSF) leak is not uncommon with endoscopic transsphenoidal surgical excision of pituitary macroadenomas. How to seal the defect and prevent postoperative leak is still a matter of debate. Objectives In patients with CSF leak, we tried to figure out which is more important in preventing postoperative leak, is it the sellar fat packing, is it tight repair of the sellar floor, or do we need to combine them both? Patients and Methods Over 5 years, in patients with evident intraoperative CSF leak, with growing experience supported by positive postoperative results, we shifted gradually from intrasellar packing using combined fat graft and bioabsorbable materials (SURGICEL FIBRILLAR/Gelfoam) (group A, n =15) to only bioabsorbable materials (group B, n = 18), either of which is followed by tight repair of the sellar floor. Results Postoperative clinical assessment did not differ significantly between both groups at early, midterm, and long-term follow-up intervals. We did not have any patients with delayed postoperative CSF leak or symptomatic empty sella syndrome (ESS). Conclusion There is no difference in the incidence of postoperative CSF leak and clinical ESS among both groups, indicating that tight sellar floor repair is more important than packing the sellar cavity with or without fat graft.

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Section: Discussionmentioning

confidence: 99%

“…5 This step passed through a process of development and evolution with a lot of used material and techniques. 4 5 6 7 8 9 10 11 12 13 14 15 16 17 21…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Sellar Floor Reconstruction with and without Intrasellar Fat Packing after Endoscopic Resection of Large Pituitary Macroadenomas with Evident Intraoperative CSF Leak

Darwish

Nanous

Hamead

et al. 2022

Indian Journal of Neurosurgery

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Endocrine Outcomes Following Endoscopic Transsphenoidal Pituitary Surgery in Erbil, Iraq

Nasser,

Ahmed

2024

Preprint

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Objective The impact of endoscopic transsphenoidal pituitary surgery (ETSs) on endocrine function is a critical concern of surgical treatment of pituitary tumors. This study evaluated post-ETSs pituitary disease control (DC), development of early and late new hormonal deficiencies, and recovery of pre-existing hormonal deficiency. Additionally, studied the preoperative factors that influence post-ETSs outcome. Methods A prospective cohort study conducted in neuroendocrine field in Erbil city from April 2023 to April 2024. The study included 35 patients who were assigned for ETSs after exclusion of those with prior neurosurgical intervention, radiation, or drugs affecting pituitary function. Initial clinical evaluation, endocrine tests and radiological imaging performed pre-ETSs, then at early postoperative period and later follow up scheduled at one-, three-, and six-month interval. Results Post-ETSs, DC achieved in 20 (57.1%) of patients. At six-month follow up, about 10/18 (55.5%) patients recovered at least one hormone postoperatively with gonadal axis was the most frequent 5 (14.3%), while new hormonal deficiencies documented in 12 (34.3%) patients, among which prolonged Diabetes insipidus (DI) was the most frequently encountered 11 (31.4%). Early post-ETSs water dysregulation significantly prolonged hospital stay (p-value 0.035). Tumor size, knops classification and surgeon experience were the main variables associated with endocrine outcome. Conclusion In Iraq, Erbil city, DC rate was lower than previous studies, and development of new hormonal deficiencies was higher and contributed to prolonged DI. However, a considerable number of patients had recovery of pre-existing hormonal deficiencies compared to prior studies. These findings necessitate revision of our surgical management.

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Endoscopic endonasal transsphenoidal surgery: predictors for disease control in a consecutive series of pituitary adenomas

Cited by 2 publications

References 34 publications

Sellar Floor Reconstruction with and without Intrasellar Fat Packing after Endoscopic Resection of Large Pituitary Macroadenomas with Evident Intraoperative CSF Leak

Sellar Floor Reconstruction with and without Intrasellar Fat Packing after Endoscopic Resection of Large Pituitary Macroadenomas with Evident Intraoperative CSF Leak

Endocrine Outcomes Following Endoscopic Transsphenoidal Pituitary Surgery in Erbil, Iraq

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