Endoscopic pituitary surgery: National database review

Al‐Qurayshi, Zaid; Bennion, Douglas M.; Greenlee, Jeremy D.W.; Graham, Scott M.

doi:10.1002/hed.27179

Cited by 8 publications

(7 citation statements)

References 34 publications

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“…Our rates of development of DI in 21.4% of patients and SIADH in 7.4% of patients are comparable to other published rates of 10 to 60% and 4 to 23%, respectively. [8][9][10][11][12][13] Our mean onset of DI at 2.6 days was comparable to previous reports of onset of less than 5 days after TSH, 9,11,18 whereas SIADH onset at 4.7 days at TSH was earlier compared with a previous report of onset at 7 days. 11 We found that older age was a negatively associated factor with development of DI, similarly to previous studies that identified younger age (e.g., less than 50 years old) as a risk factor for development of DI.…”

Section: Discussionsupporting

confidence: 84%

“…11 These complications directly impact postoperative course and patient care, with previous studies documenting the rate of transient DI following transsphenoidal adenoma resection varying from 10 to 60%. [8][9][10][11][12][13] Although DI peaks on average at postoperative day 5 and dissipates by day 11, rates of persistent DI lasting longer than 3 months have been observed to range from 2 to 10.1%. 8,10,11 SIADH occurs at slightly less common rates of 4 to 23% of pituitary adenoma resection patients and occurs around postoperative day 7.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Development of Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone Secretion after Transsphenoidal Resection of Pituitary Adenoma

Petito,

Hu,

Zhang

et al. 2023

J Neurol Surg B Skull Base

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Background: We aimed to determine the incidence and risk factors for development of diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) after transsphenoidal hypophysectomy (TSH) for resection of a pituitary adenoma. Methods: This was a retrospective study of 403 adult patients undergoing TSH for pituitary adenoma. Clinical variables, tumor characteristics, and operative factors were collected. Incidences of DI and SIADH were determined, including timing in the peri-operative period. Independent predictors of developing DI and SIADH were identified using multivariable logistic regression. Results: Following TSH, 21.3% of patients developed DI at a mean 2.6 days and 7.4% developed SIADH at a mean 4.7 days. DI was negatively associated with older age (OR=0.98, 95%CI: 0.96–0.99, p=0.029). DI was positively associated with female sex (OR=2.26, 95%CI: 1.24–4.11, p=0.008), increase in A-P tumor size (OR=1.54, 95%CI: 1.11–2.13, p=0.010), intraoperative CSF leak (OR=2.29, 95%CI: 1.25–4.19, p=0.008), and every 100 mL of estimated blood loss (EBL) (OR=1.18, 95%CI: 1.01–1.39, p=0.046). Development of SIADH was positively associated with intraoperative CSF leak (OR=3.56. 95%CI: 1.24–10.21, p=0.018) on multivariate analysis. Conclusion: DI and SIADH occur in the minority of patients undergoing TSH, but vigilance for their development must be maintained for days after the surgery. Development of DI after TSH is multifactorial, having possible patient-specific risk factors and risk related to the complexity of surgical dissection, reflected by tumor size, intraoperative CSF leak, and EBL. Development of SIADH could be associated with intraoperative CSF leak occurrence.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Development of Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone Secretion after Transsphenoidal Resection of Pituitary Adenoma

Petito,

Hu,

Zhang

et al. 2023

J Neurol Surg B Skull Base

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“…15 A 2010 to 2015 study of the Nationwide Readmissions Database reported a 0.7% risk of epistaxis after TSS for pituitary adenoma, while a 2018 single-institution study reported an epistaxis rate of 1.1%. 16,17 This single-institution study also reported a 1.1% risk of postoperative hematoma after TSS for pituitary adenoma. 17 A feared complication is suprasellar hematoma, which can affect vision.…”

Section: Discussionmentioning

confidence: 57%

Significant Variability in Postoperative Thromboprophylaxis in Cushing's Disease Patients: A Survey of the North American Skull Base Society and the AANS/CNS Joint Tumor Section

White,

Almeida,

Petitt

et al. 2023

J Neurol Surg B Skull Base

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Introduction Cushing's disease (CD) is associated with hypercoagulability which is associated with an increased risk of venous thromboembolic events (VTEs) perioperatively. This risk persists even after successful transsphenoidal surgery (TSS). However, there are no current guidelines for pharmacologic thromboprophylaxis in this patient population. Objective Characterize existing thromboprophylaxis management practices in patients undergoing TSS for CD. Methods An anonymous RedCap survey comprised of questions about perioperative thromboprophylaxis in CD patients was distributed via the American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Joint Tumor Section and the North American Skull Base Society (NASBS) email lists. Results The survey was distributed to 554 members of the AANS/CNS Joint Tumor Section and 1,094 members of NASBS asking that members who surgically treat CD respond. Sixty responses (3.0% response rate) were received. Fifty-two (86.7%) respondents are involved in the postoperative management of CD patients. Thirty-six (69.2%) treat all patients with postoperative VTE chemoprophylaxis, 8 (15.4%) treat some patients, while 8 (15.4%) do not use chemoprophylaxis. Preferred chemoprophylaxis varies as 26 (59.1%) administer low molecular weight heparin, 14 (31.8%) give unfractionated heparin, 1 (2.3%) give direct oral anticoagulants, and 3 (6.8%) give aspirin. Most (28, 53.8%) of the respondents perceive the VTE risk in this patient population to be 0 to 5%, 16 (30.8%) perceive the risk to be 6 to 10%, and 8 (15.4%) perceive it to be 11 to 20%. Conclusion There is great variability in VTE detection and postoperative prevention practice patterns in CD patients. This study highlights the need for prospective studies to clarify optimal pharmacologic chemoprophylaxis strategies and duration in this patient population.

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“…The rate of CSF leakage in an American national database including 5891 patients was 8.35%. 38 Duz et al reported that CSF leakage occurred in 11% of his endoscopic group. 42 A paper published in 2020 with 270 patients, including pituitary adenomas among other pathologies, found a 9% incidence of CSF leak.…”

Section: Discussionmentioning

confidence: 95%

Our experience with Endoscopic Transnasal Transsphenoid Resection of Pituitary Adenomas

Mahmoud,

Eid,

Abd Elrahman

et al. 2023

Pan Arab Journal of Neurosurgery

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The two most common subtypes of Pituitary adenomas are Prolactinomas and non-functioning adenomas. Patients usually present with infertility, diminished libido, galactorrhea, visual manifestations, headache or manifestations of endocrine malfunction. Regarding Prolactinomas, medical treatment is usually administered before surgical resection, as most prolactinomas are highly responsive to it. Since the advent of endoscopic equipment, the transsphenoidal approach has been the surgical method of choice for treatment of pituitary adenomas. OBJECTIVE:To evaluate the endoscopic transnasal transsphenoidal approach for resection of Pituitary adenomas in our institute in terms of the degree of tumor resection, the clinical, visual and endocrinological outcomes, and the complications. PATIENTS AND METHODS:This is a retrospective single-institute study of 56 patients who underwent endoscopic transnasal transsphenoidal resection of pituitary macroadenomas and microadenomas in Suez Canal University Hospital from 01 January 2018 to 31 June 2022. We evaluated the endoscopic transnasal transsphenoidal approach for resection of pituitary adenomas in terms of the degree of tumor resection, clinical, visual and endocrinological outcomes, and complications. RESULTS:In 43 patients (76.8%), gross total resection was accomplished. Endocrinological improvement was seen in 21 out of 24 patients with functioning adenomas (87.5%), including 16 patients with prolactinomas, and visual improvement was seen in 14 out of 16 patients with visual field impairment (87.5%). Seven patients (13%) experienced postoperative diabetes insipidus (DI), including three patients (5%) who had the condition for an extended period. Despite using fibrin glue and a multilayer closure, we had one patient (1.8%) with cerebrospinal fluid (CSF) leak. In this case, surgical exploration was performed, and a high-flow CSF leak was found despite the standard skull base reconstruction performed in the initial operation. A pedicled right middle turbinate flap was used for repair with stoppage of CSF leak. Five of our patients (8.9%) experienced recurrence. We did not experience major morbidities (meningitis, carotid artery or optic nerve injuries), and there were no mortalities.CONCLUSION: Endoscopic transnasal transsphenoidal resection of pituitary macroadenomas and microadenomas is a safe technique in experienced hands. A sounding knowledge of anatomy along with a detailed study of patients imaging is our map and roadmap.

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Endoscopic pituitary surgery: National database review

Cited by 8 publications

References 34 publications

Risk Factors for Development of Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone Secretion after Transsphenoidal Resection of Pituitary Adenoma

Risk Factors for Development of Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone Secretion after Transsphenoidal Resection of Pituitary Adenoma

Significant Variability in Postoperative Thromboprophylaxis in Cushing's Disease Patients: A Survey of the North American Skull Base Society and the AANS/CNS Joint Tumor Section

Our experience with Endoscopic Transnasal Transsphenoid Resection of Pituitary Adenomas

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