Endoscopic Transsphenoidal Treatment in Recurrent and Residual Pituitary Adenomas - First Experience

Zawadzki, T; Gałuszka-Ignasiak, B; Bazowski, P; Duda, Izabela; Wojtacha, Maciej; Rudnik, Adam; Krawczyk, Ireneusz

doi:10.1055/s-2006-932126

Cited by 46 publications

(43 citation statements)

References 12 publications

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“…22,28,39 CSF leakage occurred in 43% of the patients in this study, intra-operatively in four patients and postoperatively in two patients. Previously, we reported a CSF leakage rate of 8·5% in primary endoscopic TS in patients with CD operated on by the same neurosurgeons that operated the patients in this study.…”

Section: Discussionmentioning

confidence: 56%

“…27 No results on repeated TS via the endoscopic technique in CD have been published till now. 27,28 In order to gain insight into the role of repeated TS as a treatment option for persistent or recurrent CD, we evaluated the remission rates and complications of repeated TS in 14 patients, treated in our hospital between 1999 and 2007. All patients were operated via the endoscopic technique.…”

Section: Introductionmentioning

confidence: 99%

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Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

Wagenmakers¹,

Netea‐Maier²,

Lindert

et al. 2009

Clinical Endocrinology

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SummaryBackground No data on results of repeated transsphenoidal surgery via the endoscopic technique for patients with persistent or recurrent Cushing's disease are available. Design and patients We retrospectively evaluated the remission rates and complications of repeated transsphenoidal surgery via the endoscopic technique in 14 patients with persistent ( N = 6) or recurrent ( N = 8) Cushing's disease treated in our centre between 1999 and 2007. Main outcomes Remission was defined as the disappearance of symptoms of hypercortisolism with basal plasma cortisol level ≤ 50 nmol/l 24-48 h after glucocorticoid withdrawal and/or suppression of plasma cortisol level ≤ 50 nmol/l after 1 mg dexamethasone overnight within the first 3 months after transsphenoidal surgery. Results With repeated endoscopic transsphenoidal surgery a remission rate of 10/14 (71%) was achieved. No patient had a relapse during a median follow-up of 24 months. Cerebrospinal fluid leakage was the most frequent complication (6 patients) and 11 patients required hormonal substitution after surgery. The success of repeated transsphenoidal surgery could not be predicted by visualization of an adenoma on MRI before first or second surgery, histopathological confirmation of an ACTH secreting adenoma after first or second surgery, treatment with cortisol lowering agents before first or second surgery, the operation technique used during the first surgery, persistent vs. recurrent disease after the first surgery, age, gender and interval between the two surgeries. Conclusion Repeated transsphenoidal surgery via the endoscopic technique is a good treatment option for selected patients with recurrent or persistent Cushing's disease following primary pituitary surgery.

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

Wagenmakers¹,

Netea‐Maier²,

Lindert

et al. 2009

Clinical Endocrinology

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“…21 Other studies looked at the use of image guidance to avoid vascular injury during repeat transsphenoidal surgery, 8 and the use of the endoscope at the time of repeat surgery for 12 4 and 20 16 patients as a means of increasing the field of view to counteract any challenges associated with repeat surgery, with the latter study reporting CSF leak requiring repair after one of 20 reoperations.…”

mentioning

confidence: 99%

Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations

Jahangiri¹,

Wagner²,

Han³

et al. 2014

JNS

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Object. While transsphenoidal surgery is associated with low morbidity, the degree to which morbidity increases after reoperation remains unclear. The authors determined the morbidity associated with repeat versus initial transsphenoidal surgery after 1015 consecutive operations.Methods. The authors conducted a 5-year retrospective review of the first 916 patients undergoing transsphenoidal surgery at their institution after a pituitary center of expertise was established, and they analyzed morbidities.Results. The authors analyzed 907 initial and 108 repeat transsphenoidal surgeries performed in 916 patients (9 initial surgeries performed outside the authors' center were excluded). The most common diagnoses were endocrine inactive (30%) or active (36%) adenomas, Rathke's cleft cysts (10%), and craniopharyngioma (3%). Morbidity of initial surgery versus reoperation included diabetes insipidus ([DI] 16% vs 26%; p = 0.03), postoperative hyponatremia (20% vs 16%; p = 0.3), new postoperative hypopituitarism (5% vs 8%; p = 0.3), CSF leak requiring repair (1% vs 4%; p = 0.04), meningitis (0.4% vs 3%; p = 0.02), and length of stay ([LOS] 2.8 vs 4.5 days; p = 0.006). Of intraoperative parameters and postoperative morbidities, 1) some (use of lumbar drain and new postoperative hypopituitarism) did not increase with second or subsequent reoperations (p = 0.3-0.9); 2) some (DI and meningitis) increased upon second surgery (p = 0.02-0.04) but did not continue to increase for subsequent reoperations (p = 0.3-0.9); 3) some (LOS) increased upon second surgery and increased again for subsequent reoperations (p < 0.001); and 4) some (postoperative hyponatremia and CSF leak requiring repair) did not increase upon second surgery (p = 0.3) but went on to increase upon subsequent reoperations (p = 0.001-0.02). Multivariate analysis revealed that operation number, but not sex, age, pathology, radiation therapy, or lesion size, increased the risk of CSF leak, meningitis, and increased LOS. Separate analysis of initial versus repeat transsphenoidal surgery on the 2 most common benign pituitary lesions, pituitary adenomas and Rathke's cleft cysts, revealed that the increased incidence of DI and CSF leak requiring repair seen when all pathologies were combined remained significant when analyzing only pituitary adenomas and Rathke's cleft cysts (DI, 13% vs 35% [p = 0.001]; and CSF leak, 0.3% vs 9% [p = 0.0009 ]).Conclusions. Repeat transsphenoidal surgery was associated with somewhat more frequent postoperative DI, meningitis, CSF leak requiring repair, and greater LOS than the low morbidity characterizing initial transsphenoidal surgery. These results provide a framework for neurosurgeons in discussing reoperation for pituitary disease with their patients.

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“…Furthermore, endoscopes provide higher safety when progressing within the sphenoidal sinus in a condition of altered anatomy after previous surgery. 7,36 The mean hospital stay for patients that underwent the 95 procedures we studied was 5.4 days; in 81% of cases, patients remained in hospital for four days or less. The mean hospital stay of Sonnenburg et al's23 patients was 4.1 days (first 15-case groups), 4.5 days (second 15-case group) and 2.4 days (third 15-case group).…”

Section: Discussionmentioning

confidence: 98%

“…10,11,15,19,21 There was no need to remove the middle turbinate in any of our cases, which is aligned with the intention of other groups that always seek to preserve the middle turbinate whenever possible. 16,25,27,30,33,36,38 Topical use of cottonoids with adrenalin at 1:1000 may have helped to locate the ostium of the sphenoidal sinus.51 Intense vasoconstriction and decreased mucosal edema resulting from the use of adrenalin facilitate the approach to the sphenoethmoidal recess without the need to remove the middle turbinate partially or totally.…”

Section: Discussionmentioning

confidence: 99%

Acesso endoscópico transnasal aos tumores selares

Santos

Zymberg

Filho

et al. 2007

Rev. Bras. Otorrinolaringol.

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Transsphenoi dal surgery for sellar region tumors is traditionally done only by neurosurgeons. The use of endoscopes has permitted a direct transnasal approach to the sphenoidal sinus, without dissection of the septal mucosa, reducing postoperative morbidity. Aim: The purpose of this study was to assess the technical difficulties, and per and postoperative complications of the otolaryngological management of the endoscopic transnasal approach to the sellar region. Material and Method: 159 patients undergoing sellar region surgery between March 2001 and December 2006 were assessed retrospectively. 91 patients who underwent 95 endoscopic transnasal procedures were included in this study. Study design: a clinical retrospective study. Results: The endoscopic transnasal technique was feasible for every patient, independent of age, anatomical variations, tumor characteristics, tumor etiology, and previous surgical history. There was no need to remove the middle turbinate or septal deviations in any of the cases. The most significant peroperative complication was CSF leak during tumor removal (13.68%). Postoperative complications were: nasal bleeding (8.42%), CSF leak (8.42%), and meningitis (2.19). Conclusion: The transnasal endoscopic approach was accomplished with minimal invasion, preserving nasal structures in all 95 procedures, independent of age, anatomical variations, tumor characteristics,tumor etiology, and previous surgical history.

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Endoscopic Transsphenoidal Treatment in Recurrent and Residual Pituitary Adenomas - First Experience

Cited by 46 publications

References 12 publications

Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

Repeated transsphenoidal pituitary surgery (TS) via the endoscopic technique: a good therapeutic option for recurrent or persistent Cushing's disease (CD)

Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations

Acesso endoscópico transnasal aos tumores selares

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