Ultrasound-assisted Microsurgery for Cushing's Disease

Knappe, Ulrich J.; Engelbach, M.; Konz, Kornelia; Lakomek, H.-J.; Saeger, Wolfgang; Schönmayr, R.; Mann, W. Alexander

doi:10.1055/s-0029-1241207

Cited by 26 publications

(11 citation statements)

References 24 publications

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“…Residual tumor detection is facilitated with iMRI, particularly when located in the para- or suprasellar area ( 77 ), to achieve rates of resection of up to 96% in unselected series ( 78 ); however, the sensitivity of the method significantly decreases when remnant lesions are smaller than 3 mm ( 79 ). Few studies reported on the use of iUS to allow targeted resection of small, hyperechoic pituitary adenomas, even in MRI-negative cases, as in the typical condition of Cushing’s disease ( 80 , 81 ), although limited experience is available. Immunohistochemistry allows the exclusion of false double pituitary lesions by detecting distinct immunochemical signatures in surgical specimens.…”

Section: Clinical Management Of Mpamentioning

confidence: 99%

Multiple Pituitary Adenomas: A Systematic Review

Budan

Georgescu

2016

Front. Endocrinol.

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PubMed, Scopus, and Web of Science Core Collection databases were systematically searched for studies reporting synchronous double or multiple pituitary adenomas (MPA), a rare clinical condition, with a vague pathogenesis. Multiple adenomas of the pituitary gland are referred to as morphologically and/or immunocytochemically distinct tumors that are frequently small-sized and hormonally non-functional, to account for the low detection rate. There is no general agreement on how to classify MPA, various criteria, such as tumor contiguity, immunoreactivity, and clonality analysis are being used. Among the component tumors, prolactin (PRL)-immunopositive adenomas are highly prevalent, albeit mute in the majority of cases. The most frequent clinical presentation of MPA is Cushing’s syndrome, given the fact that in more than 50% of reported cases at least one lesion stains for adrenocorticotrophic hormone (ACTH). Plurihormonal hyperactivity may be diagnosed in a patient with MPA when more than one tumor is clinically active (e.g., ACTH and PRL) or in cases with at least one composite tumor (e.g., GH and PRL), to complicate the clinical scenario. Specific challenges associated with MPA include high surgical failure rates, enforcing second-look surgery in certain cases, and difficult preoperative neuroradiological imaging evaluation, with an overall sensitivity of only 25% for magnetic resonance imaging to detect distinct multiple tumors. Alternatively, minor pituitary imaging abnormalities may raise suspicion, as these are not uncommon. Postoperative immunohistochemistry is mandatory and in conjunction to electron microscopy scanning and testing for transcription factors (i.e., Pit-1, T-pit, and SF-1) accurately define and classify the distinct cytodifferentiation of MPA.

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Section: Clinical Management Of Mpamentioning

confidence: 99%

Multiple Pituitary Adenomas: A Systematic Review

Budan

Georgescu

2016

Front. Endocrinol.

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“…53 Intraoperative CT was the first modality to allow direct detection of tumor residuals, but due to its restricted selectivity in defining soft-tissue differences, it was not well accepted. 57 Intraoperative MR imaging, 2,3,6,8,15,16,21,22,25,35,44,49,51,[54][55][56][59][60][61]69,70,74,80 ultrasonography and Doppler ultrasonography, 4,5,20,39,64 and endoscopy 14,19,27,28,70 are the complementary tools used in today's procedures. Recently published studies addressed the efficiency of iMR imaging in transsphenoidal surgery in different patient groups (such as acromegaly, 22 craniopharyngioma, 55 and giant pituitary adenoma 6 ).…”

Section: Discussionmentioning

confidence: 99%

Intraoperative magnetic resonance imaging and early prognosis for vision after transsphenoidal surgery for sellar lesions

Berkmann¹,

Fandiño²,

Zosso³

et al. 2011

JNS

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“…11 The pars intermedia is a recognized location for ACTHsecretory microadenomas and is the typical location for RCC for embryological reasons. 12,13 The pars nervosa or posterior lobe of the gland is rarely affected by cysts or tumors. Oldfied's group has reported 12 patients with Cushing disease in whom an ACTH-staining adenoma was contained entirely within the posterior lobe of the pituitary.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Infrasellar Approach to the Sellar and Suprasellar Regions: Technical Note

Paluzzi¹,

Fernández-Miranda

Pinheiro‐Neto³

et al. 2011

Skull Base

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We report a technical variation of the endoscopic endonasal approach to the sellar and suprasellar regions which relies on the use of a 45-degree angled endoscope. The socalled ''infrasellar approach'' aims at excising lesions situated within the intermediate and posterior lobes of the pituitary gland without damaging the anterior lobe, thus potentially minimizing endocrinological morbidity. In this regard the endoscopic infrasellar approach might be advantageous in selected cases when compared with the traditional transsphenoidal approach with the microscope. We describe the technique and illustrate it with representative clinical cases.

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Ultrasound-assisted Microsurgery for Cushing's Disease

Abstract: Intraoperative scanning of the pituitary gland with high-frequency-ultrasound probes may identify intrapituitary anatomy and pathologies even in MRI-negative cases. This may prevent extensive exploration of the gland with the risk of subsequent hypopituitarism.

Cited by 26 publications

References 24 publications

Multiple Pituitary Adenomas: A Systematic Review

Multiple Pituitary Adenomas: A Systematic Review

Intraoperative magnetic resonance imaging and early prognosis for vision after transsphenoidal surgery for sellar lesions

Endoscopic Endonasal Infrasellar Approach to the Sellar and Suprasellar Regions: Technical Note

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