Surgical outcome of the endoscopic endonasal approach for non-functioning giant pituitary adenoma

Nakao, Naoyuki; Itakura, Toru

doi:10.1016/j.jocn.2010.04.049

Cited by 82 publications

(54 citation statements)

References 30 publications

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“…It is worth emphasizing that only one purely endoscopic surgical series was included in their analysis, since the manuscript by de Paiva Neto et al 24 was mainly microscopic transphenoidal. Thereafter, few studies came out in the literature addressing the outcomes of patients undergoing resection for large and giant pituitary adenomas by the endoscopic approach 6,8,10,11,13,14,15,16 . Their main surgical outcomes and complications rates are detailed on Tables 3 and 4 …”

Section: Discussionmentioning

confidence: 99%

“…The open and microscopic cohorts revealed better outcomes, however (9.1% and 9.5%, respectively) 7 . Even though Nakao and Itakura 16 and Juraschka et al 10 reported lower rates of new postoperative hypopituitarism, the endocrine outcomes seems to correlate inversely with the greater extent of resection and therefore with the greater surgical manipulation provided by the endoscope.…”

Section: Clinical Outcomes Of the Endoscopic Endonasal Transsphenoidamentioning

confidence: 96%

“…Such higher rates of GTR are quite encouraging in comparison to the open and microscopic transsphenoidal groups (9.6% and 30.9%, respectively) 7 . It is worth discussing that cavernous sinus involvement is reported by most of the studies as the major limitation to GTR with the endoscopic approach 6,8,14,16 , whereas for the microscopic transsphenoidal approach is the suprasellar extension multilobular configuration and extension to the middle fossa 15 are also reported to have a negative impact on surgical resection rates by the endoscopic technique.…”

Section: Extent Of Resection Of the Endoscopic Endonasal Transsphenoimentioning

confidence: 99%

“…Even though a fair comparison cannot be performed, because of a different definition for STR (residual tumor > 10-20%) 7 , the endoscopic rates of decompression are at least similar to open and microscopic transsphenoidal groups (78.8% and 81.2%, respectively) 7 . Finally, the surgical technique used by most of the endoscopic endonasal series is the standard approach, in which a wide exposure of the sellar floor is obtained from the medial walls of the cavernous sinus laterally, the tuberculum sellae cranially and the dural indentation of the clivus/inferior transcavernous sinus caudally 6,8,10,11,14,16 . Some studies have used the extended transplanum/transtuberculum endonasal approach to address some dumbbell-shaped or suprasellar adenomas or even fibrous tumors 6,8,10,13,14,15 .…”

Section: Extent Of Resection Of the Endoscopic Endonasal Transsphenoimentioning

confidence: 99%

“…Some recent reports have described the usefulness of the endoscopic endonasal route in the their management, even though its safety and effectiveness of treating large and giant pituitary adenomas is yet to be established in the literature 6,8,10,11,13,14,15,16 . Herein, we sought to 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 approachrelated complications.…”

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confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Clinical Outcomes Of the Endoscopic Endonasal Transsphenoidamentioning

confidence: 96%

Section: Extent Of Resection Of the Endoscopic Endonasal Transsphenoimentioning

confidence: 99%

Section: Extent Of Resection Of the Endoscopic Endonasal Transsphenoimentioning

confidence: 99%

mentioning

confidence: 99%

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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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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

157

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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