Background : The purpose of this study was to report the outcomes and complications of single-surgeon endoscopic endonasal transsphenoidal surgery for pituitary adenomas and compare the findings with those in published studies. Materials and Methods : We reviewed the data for 197 endoscopic procedures performed for pituitary adenomas between January 2001 and December 2016. Demographic, endocrinological, and radiological data as well as the surgical outcomes and complications were retrospectively analyzed. Results : There were 98 nonfunctioning adenomas and 99 hormone-secreting adenomas. The rate of gross total resection was 64.0%. Hormonal remission was achieved for 71.7% hormone-secreting adenomas after a median follow-up of 40 months. The overall complication rate was 33.5% (21.3% of minor and 13.2% of major complications) after 197 surgeries. The most common complication was transient diabetes insipidus (DI, 12.2%). There were 26 cases of major complications; two permanent DI, nine anterior pituitary dysfunctions, six postoperative cerebrospinal fluid leak with revision surgery. There were postoperative hemorrhage in three patients, three meningitis in three (1.5%); 50% of these patients died of these complications. Conclusions : Our findings suggest that, compared with conventional microscopic surgery, endoscopic endonasal pituitary surgery can be less invasive and provide better visualization. Although microscopic surgery performed by experienced surgeons can achieve satisfactory results, we believe that endoscopic pituitary surgery will be more widely used because of the favorable outcomes and minimal invasiveness.
We evaluated the trend of admission of patients with acute cerebrovascular accidents (CVAs) during social distancing measures implemented during the coronavirus disease 2019 (COVID-19) era. The data of patients admitted with transient ischemic attack, ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) to the emergency department of the Hanyang University Seoul Hospital were retrospectively analyzed. The data were compared between the pre-COVID-19 and COVID-19 periods. Poisson regression analysis was performed to evaluate changes in admission rates as a function of the year, social distancing level, and the interaction between the year and social distancing level. The number of admissions for CVAs dropped from 674 in the pre-COVID-19 period to 582 in the COVID-19 period. The decline in the number of admissions for ICH during social distancing measures was statistically significant, while the declines in SAH and ischemic stroke admissions were not. When the social distancing level was raised, admissions for CVAs dropped by 19.8%. The correlation between social distancing and decreased admissions for CVAs is a paradoxical relationship that may be of interest to the field of public health.
A disproportionately large communicating fourth ventricle (DLCFV) is a rare condition. A 34-year-old man experienced severe headaches, nausea, vomiting, and gait disturbance. Initial brain computed tomography (CT) showed markedly dilated ventricles with prepontine cistern shrinkage. Following extraventricular drain (EVD) insertion, approximately 400 mL/d of cerebrospinal fluid (CSF) was removed over 8 days. During this time, no significant changes in ventricle size were observed on CT images or the facial pain scale (FPS). We then performed an endoscopic third ventriculostomy and changed the drainage catheter. Immediately after surgery, the patient’s symptoms were relieved, and the drainage volume gradually decreased. EVD was successfully removed on the eighth postoperative day. Our experiences suggest that neurosurgeons should consider the importance of a third ventriculostomy for the diagnosis and treatment of DLCFV.
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