Pressure-irrigation-suction system technical note

Lüdecke, D. K.; Treige, W.

doi:10.1007/bf01809311

Cited by 31 publications

(16 citation statements)

References 5 publications

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“…Only since the development of the first micropressure-irrigation-suction system in neurosurgery, introduced by the senior author in 1980, were we able to safely remove extrasellar tumor parts under clear vision of slightly modified slim mirrors [24, 25]. With these tools, the additional use of an endoscope was rarely found to be of advantage for us.…”

Section: Resultsmentioning

confidence: 99%

Transsphenoidal Microsurgery for Newly Diagnosed Acromegaly: A Personal View after More than 1,000 Operations

Lüdecke¹,

Abe

2006

Neuroendocrinology

108

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The aim of this short review is to inform about the possibilities and limits of transnasal microsurgery in acromegaly. The current reports on surgical remissions, according to the strict criteria with international consensus using age- and sex-related normal levels for insulin-like growth factor-I and suppression of growth hormone (GH) with oral glucose tolerance below 1 µg/l, are more or less agreeable with values between 34 and 74%. In microadenomas (<10 mm in diameter), 59–95% remissions are published. Some improvement might be achieved in macroadenomas which presently have a chance of 26–68% to be satisfactorily operated on. Special instruments introduced by us to visualize and remove partially invasive adenoma parts are described. Intraoperative magnetic resonance imaging is discussed. With intraoperative measurement of GH, small adenoma rests <3 mm can be diagnosed. When GH did not sufficiently decline, an additional tumor search resulted in a significant improvement in results in resectable macroadenomas. With these techniques, we achieved remission rates which can hardly be further increased (micros 95%, macros 68%). In grossly invasive grade 4 adenomas, which are frequent in our unit, only an 80–95% reduction in tumor mass is feasible. Preoperative treatment with somatostatin analogues as used in most of our patients reduces the comorbidity and facilitates adenoma removal which is still controversially discussed in the literature. The complication rate of microsurgery in experienced hands is low.

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Section: Resultsmentioning

confidence: 99%

Transsphenoidal Microsurgery for Newly Diagnosed Acromegaly: A Personal View after More than 1,000 Operations

Lüdecke¹,

Abe

2006

Neuroendocrinology

108

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“…Direct transnasal approach to the sellar region through one nostril was applied in all patients, the operative technique of which has been described in detail elsewhere [7,16,18]. Tumor was removed piecemeal with blunt curettes using a micro-pressureirrigation-suction system with different tips under mirror control, especially within extrasellar parts.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Effectiveness of Secondary Transnasal Surgery in GH-Secreting Pituitary Macroadenomas

2003

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Abstract. Transsphenoidal surgery is the first therapeutic option in acromegaly, but the management of persistent or recurrent cases of the disease after surgery has been controversial. This study presented the results of secondary transnasal surgery for residual or recurring growth hormone (GH)-secreting macroadenoma with reference to intraoperative GH measurement. It focused on 22 patients who underwent secondary transsphenoidal surgery for 18 residual and 4 recurring GH-secreting pituitary macroadenomas from 1990 to 1999. To assess complete tumor removal, plasma GH concentration was measured intraoperatively. Before secondary surgery, plasma GH levels without medical treatment ranged from 2.0 to 239.0 mg/l (mean 31.5 +/-50.4). Magnetic resonance imaging demonstrated 16 transnasally resectable tumors and 6 nonresectable grossly invasive tumors. Intraoperative plasma GH concentrations declined sufficiently in 9 of 16 with transnasally resectable tumors, but in the remaining 7 cases the tumors were further explored and normalization of GH levels was ultimately obtained in 4 out of these cases. It was impossible to completely remove the tumors in all the 6 patients with transnasally nonresectable tumors. Thirteen of 22 patients achieved endocrinological remission by rigorous criteria. In transnasally resectable tumors, the endocrinological remission rate was 81.3% (13 of 16 patients) with no recurrence during the follow-up period of at least 4 years. Secondary transnasal surgery for residual or recurring GHsecreting pituitary macroadenomas is a safe and effective treatment, if done along with intraoperative GH measurement. Endocrinological remission can be obtained with high probability in patients who suffer from macroadenomas with suprasellar extension, with the exception of transnasally nonresectable grossly invasive tumors.

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“…or under his supervision. The tumour was removed piecemeal using blunt curettes under a micro pressure–suction–irrigation system (Lüdecke & Treige, 1982). Upon complete tumour removal the access was closed, but the patient remained under anaesthesia.…”

Section: Clinical Methods and Materialsmentioning

confidence: 99%

Recent primary transnasal surgical outcomes associated with intraoperative growth hormone measurement in acromegaly

Abe

Lüdecke

1999

Clinical Endocrinology

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Pressure-irrigation-suction system technical note

Cited by 31 publications

References 5 publications

Transsphenoidal Microsurgery for Newly Diagnosed Acromegaly: A Personal View after More than 1,000 Operations

Transsphenoidal Microsurgery for Newly Diagnosed Acromegaly: A Personal View after More than 1,000 Operations

Effectiveness of Secondary Transnasal Surgery in GH-Secreting Pituitary Macroadenomas

Recent primary transnasal surgical outcomes associated with intraoperative growth hormone measurement in acromegaly

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