Minimally Invasive Pituitary Surgery

Senior, Brent A.; Ebert, Charles S.; Bednarski, Karen K.; Bassim, Marc K.; Younes, Mahar; Sigounas, Dimitri; Ewend, Mathew G.

doi:10.1097/mlg.0b013e31817e2c43

Cited by 88 publications

(90 citation statements)

References 41 publications

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“…5 Despite a superior safety profile and decreased morbidity relative to transcranial approaches, TSS harbors risks, including a potential for hypopituitarism as well as cerebrospinal fluid (CSF) leak. [6][7][8][9][10][11] Some have suggested the latter risk is especially pronounced in Cushing's disease, characterized by poor wound healing due to a high cortisol environment. 12,13 Nonetheless, population-based studies definitively illustrating an increased CSF leak rate in Cushing's disease patients are lacking.…”

Section: Introductionmentioning

confidence: 99%

Inpatient Complications After Transsphenoidal Surgery in Cushing’s Versus Non-Cushing’s Disease Patients

Svider

Raikundalia

Pines

et al. 2015

Ann Otol Rhinol Laryngol

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Objective: Transsphenoidal surgery (TSS) harbors a potential for hypopituitarism, cerebrospinal fluid (CSF) leaks, and other complications. We utilized the Nationwide Inpatient Sample Database (NIS) to compare inpatient complication rates between Cushing's disease (CD) and non-Cushing's disease (NCD) patients undergoing TSS. Methods: Inpatient hospitalization data for 960 CD and 12 110 NCD patients who underwent TSS between 2002 and 2010 were accessed. Demographic information, outcomes, and complication rates were evaluated. Results: Patients with CD had a female predilection (81.7%) and were younger (40.5 ± 14.4 years) than NCD patients (47.8% female; 52.1 ± 16.3 years) (P < .001). Length of stay and total charges did not differ between groups. Patients with CD had significantly greater postoperative diabetes insipidus rates (14.0% vs 9.6%, P < .001) and urinary/renal complications (1.7% vs 0.9%, P = .027). After adjusting for possible confounders, the relationship between urinary/renal complications and CD status strengthened. There was no difference in rates of CSF leak and iatrogenic pituitary disorders overall. Conclusion: No differences were noted in the rate of early CSF leaks between postoperative TSS CD and NCD patients. Postoperative diabetes insipidus did not significantly differ between groups after adjusting for confounders. Only odds of urinary/renal complications in CD patients was significant after adjustment.

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Section: Introductionmentioning

confidence: 99%

Inpatient Complications After Transsphenoidal Surgery in Cushing’s Versus Non-Cushing’s Disease Patients

Svider

Raikundalia

Pines

et al. 2015

Ann Otol Rhinol Laryngol

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“…This technique of a minimally invasive endoscopic transnasal transsphenoidal approach is increasingly being utilized for lesions of the sella and anterior skull base. 3 This approach avoids a septoplasty and a sublabial incision compared with microscopic approaches previously utilized. 4 The endoscopic approach requires the expertise of a two surgeon team composed of an otolaryngologist and a neurosurgeon, each of whom performs essential portions of the procedure, to provide a safe approach to anterior skull base lesions.…”

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confidence: 99%

Evolution of Sinonasal Symptoms Following Endoscopic Anterior Skull Base Surgery

et al. 2010

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To assess the severity and evolution of sinonasal symptoms in patients following endoscopic anterior skull base surgery to define the typical postoperative course. Design: Cross sectional study. Participants include 69 patients who underwent endoscopic skull base surgery by a dual surgeon team (otolaryngologist and neurosurgeon) from January 2008 to August 2009. Main outcome measures: Sinonasal Outcomes Test (SNOT)-20 survey scores at preoperative and at three postoperative time points. An ordinal logistic regression model was used to analyze the data, summarizing the relationship between the outcome (SNOT score) and the predictor (time point) using an odds ratio. Scores for the symptoms of need to blow nose, sneezing, runny nose, postnasal discharge, thick nasal discharge, ear fullness, and facial pain showed significant worsening at the early postoperative time point. These symptoms showed significant improvement over time; however, scores for post nasal discharge remained high at the late time period compared with baseline. All patients will experience considerable sinonasal symptoms following transnasal endoscopic skull base surgery. Postnasal discharge and thick nasal discharge improve significantly over time. Symptoms approach baseline by 6 to 9 months following surgery.

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“…In the literature, nasal complications such as septal drilling, synechia, and abscesses are significantly lower when compared to the microsurgical transseptal or sublabial approach 28,29 . The success rate in the removal of pituitary tumors through the endoscopic transnasal approach is comparable to or higher than that of the microsurgical technique, reaching more than 95% of total removal id n cases of adenomas 7,30 .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transnasal approach for removing pituitary tumors

Castro

Michel²,

Denaro

et al. 2014

Arq. Neuro-Psiquiatr.

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To describe a series of 129 consecutive patients submitted to the resection of pituitary tumors using the endoscopic transsphenoidal approach in a public medical center. Method: Retrospective analysis based on the records of patients submitted to the resection of a pituitary tumor through the endoscopic transsphenoidal approach between 2004 and 2009. Results: One hundred and twenty-nine records were analyzed. The tumor was non-secreting in 96 (74.42%) and secreting in 33 patients (22.58%). Out of the secretory tumors, the most prevalent was the growth hormone producer (7.65%), followed by the prolactinoma, (6.98%). Eleven patients developed cerebral spinal fluid (CSF) fistulas, and four of them developed meningitis. One patient died due to intracerebral hemorrhage in the postoperative period. Conclusion: The endoscopic transsphenoidal approach to sellar tumors proved to be safe when the majority of the tumors were nonsecreting. The most frequent complication was CSF. This technique can be done even in a public hospital with financial limits, since the health professionals are integrated.Keywords: pituitary neoplasms, cerebrospinal fluid, fistula, sphenoid sinus. RESUMO Descrever uma série de 129 pacientes submetidos à ressecção de tumor de hipófise com acesso endoscópico transesfenoidal em um serviço de público referência em Belo Horizonte. Método: Análise retrospectiva realizada por análise dos prontuários de pacientes submetidos à ressecção de tumor de hipófise com acesso endoscópico transesfenoidal entre os anos 2004 e 2009. Resultados: Foram avaliados 129 prontuários. O tumor era não secretante em 96 (74,42%) e secretante em 33 pacientes (22,58%). Dos tumores secretores, o de maior prevalência foi o produtor de hormônio do crescimento: 15 pacientes (7,65%). Onze pacientes desenvolveram fístula liquórica. Um paciente faleceu devido hemorragia intracerebral no pós-operatório. Conclusão: O acesso endoscópico transfenoidal aos tumores selares mostrou-se seguro numa população em que a maioria dos tumores era não secretante. A principal complicação encontrada foi fístula liquórica. Esta técnica é passível de utilização em hospital público mesmo com limites financeiros desde que haja integração multiprofissional.Palavras-chave: neoplasias hipofisárias, líquido cefalorraquidiano, fistula, seio esfenoidal.Transnasal approaches to the sella turcica have been used since 1910 when the incision in the gingivolabial groove associated with the transseptal approach was introduced. Subsequently, the sublabial incision was combined with the septal submucous incision, preserving the nasal function and avoiding scarring 1 . The use of intraoperative fluoroscopy and microscope in the 1960s represented an important advance, replacing craniotomy and reducing the rate of surgical mortality to less than two percent. The transseptal approach associated with the use of the microscope remained the gold standard of the transsphenoidal approach for more than 30 years and is still the preferred method in some centers 2 . The popul...

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Minimally Invasive Pituitary Surgery

Cited by 88 publications

References 41 publications

Inpatient Complications After Transsphenoidal Surgery in Cushing’s Versus Non-Cushing’s Disease Patients

Inpatient Complications After Transsphenoidal Surgery in Cushing’s Versus Non-Cushing’s Disease Patients

Evolution of Sinonasal Symptoms Following Endoscopic Anterior Skull Base Surgery

Endoscopic transnasal approach for removing pituitary tumors

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