Anatomic Variations in Pituitary Endocrinopathies: Implications for the Surgical Corridor

Kuan, Edward C.; Yoo, Frederick; Kim, Won; Heineman, Thomas C.; Badran, Karam W.; Bergsneider, Marvin; Wang, Marilene

doi:10.1055/s-0036-1579934

Cited by 2 publications

(2 citation statements)

References 19 publications

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“…In this study, we noticed a higher incidence of postoperative CSF leak in cases of acromegaly and Cushing type of adenoma; one case associated with empty sella syndrome. This difference from the literature can be explained by the great anatomical variation of the skull base in these two types of adenomas [4,21].…”

Section: Discussioncontrasting

confidence: 65%

Predictors of Cerebrospinal Fluid Leaks in Endoscopic Surgery for Pituitary Tumors

Saad¹,

Elkahwagi²,

Musaad³

et al. 2019

IJN

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Background: Cerebrospinal fluid (CSF) leak is a serious complication of endoscopic endonasal surgery for pituitary adenoma; leading to a more serious and financial burden of the surgery. Prediction of the occurrence of such sequale and proper plaining for reconstruction can reduce its prevalence and associated morbidities. Purpose: To determine the predictors and risk factors associated with intra/and postoperative cerebrospinal fluid (CSF) leaks in endoscopic endonasal pituitary surgery. Methods: A retrospective study included 150 patients who underwent endoscopic endonasal approach for resection of pituitary adenomas between 2015 and 2018. We analyzed the association between CSF leaks (intra/post-operative) and perioperative variables including patients' demographic data, medical comorbidities, tumor characteristics and operative data (rates of intraoperative leak, reconstructive techniques). Results: 34 patients (22.6%) out of the 150 patients had an overall, CSF leak: 26 (76.5%) patients had intraoperative leaks; 5 patients out of them continued to have a postoperative leak. 8 patients (23.5%) had postoperative leak. Based on multiple logistic regression model analysis; increased body mass index (BMI), associated hydrocephalus, suprasellar extension and recurrent tumors had a significant association with intraoperative CSF leaks, while only BMI and hydrocephalus predicted postoperative CSF leaks. Conclusion: Elevated BMI, suprasellar extension of the tumor, recurrence or previous radiation are all important risk factors that have been proved in this study to have statistically significant association with the incidence of CSF leak. In high risk patients for CSF leakage: adequate reconstruction planis advised to avoid such morbidity.

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Section: Discussioncontrasting

confidence: 65%

Predictors of Cerebrospinal Fluid Leaks in Endoscopic Surgery for Pituitary Tumors

Saad¹,

Elkahwagi²,

Musaad³

et al. 2019

IJN

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“…10 In the adult literature, the prevalence of the conchal and presellar patterns is much lower, together accounting for less than 10% to 20% of cases. 15,16 However, in the pediatric population, sphenoid pneumatization begins around age 3 years and is generally complete around age 10 to 14 years. 4 The growth pattern seems to proceed in a temporal and posterior fashion.…”

Section: Discussionmentioning

confidence: 99%

Lack of Sphenoid Pneumatization Does Not Affect Endoscopic Endonasal Pediatric Skull Base Surgery Outcomes

et al. 2018

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Objectives/Hypothesis Currently, due to the rarity of pathology, there are limited data surrounding outcomes of pediatric skull base surgery. Traditionally, surgeons have proceeded with caution when electing endonasal endoscopic transsellar/transplanum approaches to the skull base in pediatric patients due to poor sphenoid pneumatization. In this study, we review outcomes of endoscopic pediatric skull base surgery based on sphenoid pneumatization patterns. Study Design Retrospective chart review. Methods A review of all cases of pediatric (age < 18 years) craniopharyngioma managed via an endoscopic endonasal approach at a tertiary academic medical center. Results A total of 27 patients were included in the analysis. The median age was 8 years. Nineteen (70%) patients were male. Presellar, sellar/postsellar, and conchal sphenoid pneumatizations were found in 6, 11, and 10 patients, respectively. There was no significant association between sphenoid pneumatization pattern and extent of resection (gross vs. subtotal, P = .414), postoperative cerebrospinal fluid (CSF) leak (P = .450), intraoperative estimated blood loss (P = .098), total operative time (P = .540), and length of stay (P = .336). On multivariate analysis, after accounting for age, sex, preoperative cranial nerve involvement, and cavernous sinus invasion, there remained no significant association between sphenoid pneumatization pattern and extent of resection (P = .999) and postoperative CSF leak (P = .959). Conclusions Sphenoid pneumatization pattern does not appear to affect outcomes in endoscopic skull base surgery in the pediatric population. Importantly, lack of sphenoid pneumatization does not impede gross total resection or increase complications. Thorough knowledge of the anatomy during the endoscopic approach is critical to optimize outcomes. Level of Evidence 4 Laryngoscope, 129:832–836, 2019

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Anatomic Variations in Pituitary Endocrinopathies: Implications for the Surgical Corridor

Cited by 2 publications

References 19 publications

Predictors of Cerebrospinal Fluid Leaks in Endoscopic Surgery for Pituitary Tumors

Predictors of Cerebrospinal Fluid Leaks in Endoscopic Surgery for Pituitary Tumors

Lack of Sphenoid Pneumatization Does Not Affect Endoscopic Endonasal Pediatric Skull Base Surgery Outcomes

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