Full Endoscopic Transsphenoidal Surgery for Pituitary Adenoma-emphasized on Surgical Skill of Otolaryngologist

Abstract

The purpose is to summarize the experience in full endoscopic transsphenoidal resection of pituitary adenoma in 28 patients by rhinologist, and introduce the surgical skill of otolaryngologist, especially skills and cautions when operating inside nose. We removed pituitary adenoma in 28 patients via entirely endoscopic transsphenoidal approach with the help of special-designed instruments; we performed the procedure bloodlessly within limited time. The skill emphasized bilateral nostrils and four hands technique which was as delicate as possible not to scratch nasal mucosa or injure nasal frame. The special instruments included curette with suction, monopolar electrotome and bipolar coagulation forceps with suction, powered surgical equipments (Diamond Bur, Irrigation Tubing for Blades and Burs for nasal endoscopic surgery). Among 28 patients, there were 16 total resections, 8 subtotal resections, 3 partial resections, and 1 only biopsy due to excessive bleeding and hard nature. Of 19 patients with preoperative visual impairment, 12 patients had postoperative improvement in visual acuity and visual field. All the procedures were finished within 60 to 90 min. Complications seldom occurred except transient diabetes insipidus, especially no nasal-related signs or complications but 1 had epistaxis. The full endoscopic transsphenoidal surgery is a promising approach for pituitary adenoma resection. Multidisciplinary collaboration will lead to optimal cure for the patients. New technique and special-designed instruments can facilitate greatly this procedure.

Visual outcomes after endoscopic endonasal pituitary adenoma resection: a systematic review and meta-analysis

“…Patients presented with visual acuity complaints in 14–84% of cases (Supplementary Table 3) [ 5 , 36 ]. Ten studies evaluated postoperative visual acuity in their case series [ 5 , 6 , 9 , 20 , 22 , 25 , 30 , 36 , 37 , 46 ]. Pooled prevalence of overall improvement was 67.5% (95% CI: 59.1–75.0%, I 2 : 86.0%, n = 163/219).…”

“…5 points) Total points (max. 10) Visual acuity and visual field studies Bokhari (2013) 2 1 3 6 Campbell (2010) 2 1 3 6 Chabot (2015) 3 1 1 7 Juraschka (2014) 3 1 2 6 Karppinen (2015) 3 1 4 8 Yildrim (2016) 3 1 2 6 Visual acuity studies Constantino (2016) [ 25 ] 3 1 1 5 De Witte (2011) [ 6 ] 2 1 2 5 Fan (2014) [ 30 ] 1 1 1 3 Visual field studies Anik (2011) [ 19 ] 3 1 4 8 Akin (2016) [ 10 ] 3 1 2 ...…”

Diagnosis and Treatment of Pituitary Adenomas

“…В то же время инфекционные осложнения в результате инвазии встречаются редко. Риск составляет 0,4-3,7 % [20,22,23]. Транссфеноидальная декомпрессия зрительного хиазма является успешной в большинстве случаев независимо от используемой методики.…”

30-Day Readmissions and Coordination of Care Following Endoscopic Transsphenoidal Pituitary Surgery: Experience with 409 Patients

“…5,9,10 Thus, perioperative management of patients undergoing surgery for pituitary tumors requires a multidisciplinary team of otolaryngologist, neurosurgeons, and endocrinologist. 11,12 Prior studies have identified 30-day unplanned readmission rates for ETPS to be 4.6 to 11.9%. 9,[13][14][15][16][17][18][19][20] Common complications include epistaxis, cerebrospinal fluid (CSF) leak, meningitis, intracranial bleed, pneumocephalus, electrolyte abnormalities, adrenal insufficiency, deep venous thrombosis, pulmonary embolism, and reoperation.…”

“…5 9 10 Thus, perioperative management of patients undergoing surgery for pituitary tumors requires a multidisciplinary team of otolaryngologist, neurosurgeons, and endocrinologist. 11 12…”