Extended transsphenoidal approach for pituitary adenomas invading the anterior cranial base, cavernous sinus, and clivus: a single-center experience with 126 consecutive cases

Zhao, Bing; Wei, Yaping; Li, Guilin; Li, Yongning; Yao, Yong; Kang, Jun; Ma, Wenbin; Yang, Yi; Wang, Renzhi

doi:10.3171/2009.3.jns0929

Cited by 85 publications

(58 citation statements)

References 37 publications

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“…Still in the immediate/short-term complication group, we have faced a cavernous sinus violation and consequently internal carotid artery injury, which lead to subarachnoid/tetraventricular haemorrhage followed by severe cerebral vasospasm and death. This is a rare complication of the transsphenoidal surgery with an estimated incidence of 1.58%-4.6% 15,26 . From the late complication group, permanent DI and nasosinusal disorders are a common occurrence.…”

Section: Complications Of the Endoscopic Endonasal Transsphenoidal Apmentioning

confidence: 99%

Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications

Constantino

Leal

Ferreira

et al. 2016

Arq. Neuro-Psiquiatr.

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Objective: In this study, we investigate our institutional experience of patients who underwent endoscopic endonasal transsphenoidal approach for treatment of large and giant pituitary adenomas emphasizing the surgical results and approach-related complications. Method: The authors reviewed 28 consecutive patients who underwent surgery between March, 2010 and March, 2014. Results: The mean preoperative tumor diameter was 4.6 cm. Gross-total resection was achieved in 14.3%, near-total in 10.7%, subtotal in 39.3%, and partial in 35.7%. Nine patients experienced improvement in visual acuity, while one patient worsened. The most common complications were transient diabetes insipidus (53%), new pituitary deficit (35.7%), endonasal adhesions (21.4%), and cerebrospinal fluid leak (17.8%). Surgical mortality was 7.1%. Conclusions: Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for large or giant pituitary adenomas, which results in high rates of surgical decompression of cerebrovascular structures.Keywords: endoscopic endonasal approach; giant pituitary adenomas; large pituitary adenomas; complication rates. RESUMOObjetivo: Neste manuscrito investigamos a experiência institucional com o acesso endonasal endoscópico transesfenoidal no tratamento de adenomas hipofisários grandes e gigantes com ênfase às complicações relacionadas ao acesso cirúrgico. Método: Foram incluídos neste estudo 28 pacientes consecutivos submetidos à cirurgia entre Março de 2010 e Março de 2014. Resultados: O diâmetro médio pré-operatório dos tumores era 4,6 cm. Uma ressecção total foi obtida em 14,3%; quase total, em 10,7%; subtotal, em 39,3% e parcial, em 35,7%. Nove pacientes evoluíram com melhora na acuidade visual, enquanto um paciente apresentou piora da função visual. As complicações mais comuns foram diabetes insipidus transitório (53%), novo défice hipofisário (35,7%), sinéquias endonasais (21,4%) e fistula liquórica (17,8%). A mortalidade cirúrgica foi 7,1%. Conclusões: A cirurgia por via endonasal endoscópica transesfenoidal é uma opção terapêutica extremamente útil para adenomas hipofisários grandes e gigantes, a resultar numa significativa descompressão das estruturas cerebrovasculares.Palavras-chave: acesso endoscópico endonasal; adenoma hipofisário gigante; adenoma hipofisário grande; índices de complicação.

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Section: Complications Of the Endoscopic Endonasal Transsphenoidal Apmentioning

confidence: 99%

Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications

Constantino

Leal

Ferreira

et al. 2016

Arq. Neuro-Psiquiatr.

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“…This implies that further study of therapeutic technique may be warranted in this patient group. Although invasion of pituitary tumors into the clivus has been described, [9][10][11][12][13][14][15][16][17][18] mostly in the form of case reports, 7,8,19 to our knowledge, this is the first study designed to systematically define the clinical and histologic correlates of clival invasion on CT in a large patient cohort.…”

mentioning

confidence: 99%

Clival Invasion on Multi-Detector CT in 390 Pituitary Macroadenomas: Correlation with Sex, Subtype and Rates of Operative Complication and Recurrence

Chen

Dai²,

Ai³

et al. 2011

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Clival invasion, a rare but potentially significant complication of pituitary adenoma, is difficult to detect on MR imaging. Because CT is widely used in adjunct guidance of pituitary surgery and it has recently been suggested that preoperative CT may add useful diagnostic information in addition to pituitary MR imaging, we performed the first large cross-sectional imaging study to define the image attributes, clinical correlates, and prognostic implications of clival invasion on CT for pituitary adenoma surgical guidance.

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“…Therefore, although high-field iMR imaging can depict tiny remnant tumors in the CS, removing these tumors requires other techniques. 8,34) Another technique to increase long-term endocrine remission rate may be intraoperative measurement of plasma hormone level, as if the plasma hormone level did not sufficiently decline, additional searching for tumor resulted in higher rate of complete tumor resection and remission. 19) T. Tanei et al…”

Section: Discussionmentioning

confidence: 99%

Use of High-Field Intraoperative Magnetic Resonance Imaging During Endoscopic Transsphenoidal Surgery for Functioning Pituitary Microadenomas and Small Adenomas Located in the Intrasellar Region

Tanei

Nagatani

Nakahara

et al. 2013

Neurol. Med. Chir.(Tokyo)

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The usefulness of 1.5-T high-field intraoperative magnetic resonance (iMR) imaging during transsphenoidal surgery for functioning pituitary adenomas was retrospectively evaluated based on longterm endocrine remission from the records of 14 patients who underwent transsphenoidal surgery with iMR imaging for functioning pituitary microadenomas and small adenomas located in the intrasellar region. The maximum tumor diameter was 9.3 ± 2.6 mm. Patients were diagnosed with acromegaly (n ＝ 7), prolactinoma (n ＝ 4), and Cushing's disease (n ＝ 3). If iMR imaging detected tumor remnants after resection, the resection cavity was reexamined and further resection was performed. Postoperative endocrine follow-up period was mean 33.7 ± 13.3 months. Tumor remnants were detected after the first resection in seven patients. Further resection was performed in five of these patients, and three achieved long-term endocrine remission. As a result, the overall long-term endocrine remission rate was 78.5% (11/14), instead of the 57.1% (8/14) that would be expected if iMR imaging had not been performed. Long-term endocrine remission had a tendency to be associated with the absence of tumor remnants on the final iMR images, but this was not significant (p ＝ 0.09). Long-term endocrine remission was associated with presence of tumor remnants in the cavernous sinus on the final iMR images (p ＝ 0.03). High-field iMR imaging is useful for depicting tumor remnants after resection, and increased the long-term endocrine remission rate for patients with functioning pituitary microadenomas and small adenomas.

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Extended transsphenoidal approach for pituitary adenomas invading the anterior cranial base, cavernous sinus, and clivus: a single-center experience with 126 consecutive cases

Cited by 85 publications

References 37 publications

Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications

Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications

Clival Invasion on Multi-Detector CT in 390 Pituitary Macroadenomas: Correlation with Sex, Subtype and Rates of Operative Complication and Recurrence

Use of High-Field Intraoperative Magnetic Resonance Imaging During Endoscopic Transsphenoidal Surgery for Functioning Pituitary Microadenomas and Small Adenomas Located in the Intrasellar Region

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