Preservation of hormonal function by identifying pituitary gland at endoscopic surgery

Linsler, Stefan; Hero-Gross, Renate; Friesenhahn‐Ochs, Bettina; Sharif, Salman; Lammert, Frank; Oertel, Joachim

doi:10.1016/j.jocn.2017.06.045

Cited by 21 publications

(17 citation statements)

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“…2%. [22][23][24][25][26][28][29][30][31][32][33][35][36][37][38][39][40][41][42][43]50 The rate of recovery from hormonal deficits in our study is greater than that found by other researchers. Most of our patients (83.9%) showed stable or improved hormonal deficits.…”

Section: Perioperative Outcomescontrasting

confidence: 65%

“…Six (10.7%) of our patients experienced this complication, whereas the existing literature estimates this complication occurring in 0%e7.7% of cases. 22,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][40][41][42][43]50 In terms of the other postoperative complications, our study showed increased rates of postoperative CSF leak and meningitis. Among our patients, 14.3% experienced postoperative CSF leak.…”

Section: Perioperative Outcomesmentioning

confidence: 92%

“…Rates of new deficits in other studies have ranged from 0% to 20%. [22][23][24][25][26][27][28][29][30][31][32][33]35,[37][38][39][40][41][42][43][50][51][52][53][54] Perioperative complications that we analyzed include the rates of hematoma requiring evacuation, diabetes insipidus, CSF leak, and meningitis. Our patients experienced a similar rate of postoperative hematoma when compared with previous studies described in the literature.…”

Section: Perioperative Outcomesmentioning

confidence: 99%

“…In our literature review, the rate of this complication ranged from 0% to 3%. 24,[26][27][28][29]33,35,39,40,42,43 Two (3. 6%) of our patients experienced this complication and required surgical evacuation of the hematoma.…”

Section: Perioperative Outcomesmentioning

confidence: 99%

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Challenges, Learning Curve, and Safety of Endoscopic Endonasal Surgery of Sellar-Suprasellar Lesions in a Community Hospital

et al. 2020

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BACKGROUND AND OBJECTIVE: Endoscopic endonasal surgery (EES) for the management of sellar, suprasellar, and anterior skull base lesions is gaining popularity. Our aim was to analyze and present the clinical outcomes of EES for the management of these lesions in a community hospital setting.-METHODS: We retrospectively reviewed the charts of 56 patients with sellar, suprasellar, and anterior skull base lesions who underwent EES between 2010 and 2018.-RESULTS: There was male predominance (53.6%) with a mean age of 54.9 AE 13.7 years. Lesions were 45 pituitary adenomas, 5 meningiomas, 3 metastatic, 1 craniopharyngioma, 1 Rathke cyst, and 1 mucocele. Gross total excision was achieved in 57.1%, subtotal excision occurred in 37.5%, and decompression and biopsy were achieved in 5.4% patients. Postoperative vision normalized or improved in 27 patients (86.1%) and was stable in 4 patients (13.9%). Recovery of a preexisting hormonal deficit occurred in 13 (23.2%) patients, and a new hormonal deficit occurred in 9 patients (16.1%). The mean hospital stay was 6.1 AE 4.9 days. Postoperative complications included cerebrospinal fluid leak in 8 patients (14.3%). Four patients (7.1%) had meningitis. Diabetes insipidus was present in 19 patients (33.9%), and postoperative intracranial hematoma requiring evacuation was necessary in 2 patients (3.6%). The mean follow-up duration was 47.5 AE 25.8 months. Lesion progression or recurrence requiring redo surgery occurred in 5 patients (8.9%). Regarding the learning curve, the postoperative cerebrospinal fluid leak, meningitis, new hormonal deficits, and diabetes insipidus decreased in the second half of the patients.-CONCLUSIONS: EES provides an effective and safe surgical option with low morbidity and mortality for the treatment of sellar, suprasellar, and anterior skull base lesions in a community hospital setting.

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Section: Perioperative Outcomescontrasting

confidence: 65%

Section: Perioperative Outcomesmentioning

confidence: 92%

Section: Perioperative Outcomesmentioning

confidence: 99%

Section: Perioperative Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

Challenges, Learning Curve, and Safety of Endoscopic Endonasal Surgery of Sellar-Suprasellar Lesions in a Community Hospital

et al. 2020

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“…The pituitary gland function is linked to the normal physiology of the human body and tightly related to the metabolism, reproduction, stress controlling and immune responses. The dynamic adjustment of pituitary gland cells to meet the hormonal requirement of the body during growth and maturation makes this master gland more appealing [24]. The heterogeneous group of tumors arises from the pituitary gland which accounts for approximately 20% of intracranial neoplasms.…”

Section: Introductionmentioning

confidence: 99%

Cyclooxygenase enzyme and PGE2 expression in patients with functional and non-functional pituitary adenomas

et al. 2020

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Background: Pituitary adenomas as multifactorial intracranial neoplasms impose a massive burden of morbidity on patients and characterizing the molecular mechanism underlying their pathogenesis has received considerable attention. Despite the appealing role of cyclooxygenase enzymes and their bioactive lipid products in cancer pathogenesis, their relevance to pituitary adenoma pathogenesis is debated and yet to be determined. Thus, the current study perused this relevance. Methods: The expression level of the isoforms of cyclooxygenase (COX-1 and COX-2) was evaluated in hormonesecreting and inactive pituitary adenoma tumors and normal pituitary tissues through Real-Time PCR. The level of PGE2, as the main product of enzymes, was assessed using enzyme immunoassay kits in patients and healthy subjects. Results: The results of the current study demonstrated that COX-1 and COX-2 expression levels were increased in pituitary tumors including non-functional pituitary adenoma (NFPA), acromegaly, Cushing's disease and prolactinoma compared with normal pituitary tissues. A significant expression level of COX-2 was observed in NFPA compared with the other pituitary tumors. Furthermore, the COX-2 expression level was significantly increased in macroadenoma and invasive tumors. The level of PGE2 was consistent with COX enzymes enhanced in pituitary adenoma tumors compared with healthy pituitary tissue. A significant elevation in the PGE2 level was detected in NFPA compared with hormone-secreting pituitary tumors. Additionally, the PGE2 level was increased in macroadenoma compared with microadenoma and in invasive compared with non-invasive pituitary tumors. The diagnostic values of cyclooxygenase isoforms and PGE2 were considerable between patients and healthy groups; however, COX-2 revealed more value in distinguishing endocrinologically active and non-active pituitary tumors. Conclusions: Data from the current study provides expression patterns of COX-1, COX-2 and PGE2 in prevalent pituitary tumors and their association with patients' clinical features which may open up new molecular targets for early diagnosis/follow up of pituitary tumor growth.

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Editorial “pituitary apoplexy—are visual deficits the only indication for emergent surgical intervention?”

Oertel

Teping

2022

Acta Neurochir

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With 2-3%, the initial haemorrhagic presentation of patients with pituitary adenomas is a rare finding [2]. Khawari and colleagues present interesting data of a retrospective multicentre cohort study on management, clinical and oncologic outcomes in such cases. In this study, patients with immediate surgical intervention were compared to those who underwent surgery within three months and with only conservative treatment. Subgroup analysis revealed comparable outcomes for all groups regarding visual and endocrinological findings. Interestingly, patients with subacute surgical therapy within three months showed higher rates of further oncological treatment -but without reaching statistical significance. However, 76% of the patients treated conservatively only did not require any additional treatment at all. Consequently, the authors suggest decision-making on the treatment modality based on visual symptoms rather than oncological aspects.Surgery in the acute phase is mainly aimed at an early decompression of the visual apparatus or cranial nerves [1]. Reported outcomes prove an effective recovery of up to 94% of visual symptoms depending on surgical timing [3,8,9]. Endocrinological improvement is less pronounced with partial recovery rates of up to 23% [7,8]. However, in our opinion, devastating headaches -as the main symptom of pituitary apoplexy -tend to move into the background in scientific reports. This may be attributed to the limited prospective long-term relevance for the patient. However, in our experience, early surgery is the most effective strategy for pain relief in these patients. Regarding low surgery-related complication rates in experienced high-volume centres,

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Preservation of hormonal function by identifying pituitary gland at endoscopic surgery

Cited by 21 publications

References 50 publications

Challenges, Learning Curve, and Safety of Endoscopic Endonasal Surgery of Sellar-Suprasellar Lesions in a Community Hospital

Challenges, Learning Curve, and Safety of Endoscopic Endonasal Surgery of Sellar-Suprasellar Lesions in a Community Hospital

Cyclooxygenase enzyme and PGE2 expression in patients with functional and non-functional pituitary adenomas

Editorial “pituitary apoplexy—are visual deficits the only indication for emergent surgical intervention?”

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