Assessment of the Efficacy of Endoscopy in Pituitary Adenoma Resection

Jarrahy, Reza; Berci, George; Shahinian, Hrayr K.

doi:10.1001/archotol.126.12.1487

Cited by 53 publications

(45 citation statements)

References 28 publications

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“…The technique has subsequently been refined and popularized, by Jho et al [10,22,23]. The initial reports on the use of this technique have highlighted the endoscope and its superior visualization and suggest that this minimally invasive technique might allow a more complete tumor removal and a reduced rate of complications [21][22][23][24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

et al. 2010

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The authors investigate the complications of transnasal transsphenoidal endoscopic surgery in the treatment of 301 patients with pituitary adenomas. A retrospective analysis of complications in 301 patients submitted to transsphenoidal transnasal endoscopic surgery at the General Hospital of Fortaleza, Brazil between January 1998 and December 2009. The complications were divided in two groups: anatomical (oronasofacial, sphenoid sinus, intrasellar, suprasellar and parasellar) and endocrinological complications (anterior and posterior pituitary dysfunctions). We observed a total of 81 complications (26.9%) in our series. Anatomical complications occurred in 8.97% (27 cases): 8 CSF postoperative leaks (2.6%), 6 cases (1.9%) of delayed nasal bleeding, 5 cases (1.6%) of sphenoidal sinusitis, 3 cases (0.9%) of carotid artery lesion, 2 cases of meningitis (0.6%) and one case (0.3%) of each of the uncommon following complications: intrasella-suprasella hematoma, pontine hematoma and chiasmaplexy. Endocrinological complications occurred in 17.9% (54 cases): additional postoperative anterior lobe insufficiency in 35 cases (11.6%), and postoperative diabetes insipidus in 19 cases (6.3%). In our series, 3 cases of deaths (not directly related to the procedure) were also observed. Endoscopic transsphenoidal surgery represents an effective option for the treatment of patients with pituitary tumor. Complications still occur and must be reduced as much as possible. Successful endoscopic pituitary surgery requires extensive training in the use of an endoscope and careful planning of the surgery. Additional improvement can be expected with greater experience and new technical developments.

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Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

et al. 2010

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“…The endoscopic endonasal approach avoids transseptal dissection, thus reducing patient discomfort and postoperative pain. The endoscope has increasingly been used in pituitary surgery since the mid 1990s either in conjunction with the microscopic technique (24) or as a pure endoscopic procedure (18,25,26). Especially the better panoramic visualization of sellar, supra-and parasellar anatomy with increased illumination and magnification are recognized as major advantages offered by the endoscopic technique (21,25,27).…”

Section: Introductionmentioning

confidence: 99%

Transsphenoidal pituitary surgery via the endoscopic technique: results in 35 consecutive patients with Cushing’s disease

Netea‐Maier

Lindert²,

Heijer³

et al. 2006

eur j endocrinol

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Objective and design: The endoscopic technique has been recently introduced in the field of transsphenoidal pituitary surgery. This technique allows inspection of sellar, supra-and parasellar structures and removal of the tumor under direct visualization, is minimally traumatic and permits easier reoperations. This is the first report on the results of endoscopic surgery for patients with Cushing's disease. Our aim was to retrospectively analyze the results of pituitary surgery in 35 consecutive patients with Cushing's disease operated in our hospital after the introduction of the endoscopic technique (1998 -2004). Methods: Remission was defined as suppression of plasma cortisol (# 50 nmol/L) after 1 mg dexamethasone overnight determined in the first 3 months after surgery and disappearance of clinical signs and symptoms of hypercortisolism. The patients were followed for an average of 27 months (range 4 to 81 months, median 20 months). Results: Pituitary MRI showed a macroadenoma in 6 patients, a microadenoma in 17 patients and no adenoma in 12 patients. After the initial surgery 27 patients (77%) were in remission. None of the patients had a relapse during follow-up. In the remaining 8 patients hypercortisolemia persisted after surgery. Three of them had a second endoscopic pituitary surgery resulting in remission in two patients. In one patient a second endoscopic pituitary surgery will soon follow. The remaining four patients were treated with radiotherapy postoperatively. Two of them were at the time of data collection in remission. One patient from the remission group had a serious epistaxis and three patients had cerebrospinal fluid leakage, one requiring an external lumbar drain, shortly after surgery. No complications were recorded in the failure group. Postoperatively 34% of all patients required substitution with levothyroxine, 40% required substitution with glucocorticoids, 17% received estrogens or testosterone and 6% still required desmopressin. Conclusions: Endoscopic transsphenoidal pituitary surgery resulted in our series of patients with Cushings disease in an excellent postoperative remission rate. A randomized clinical trial, comparing endoscopic and conventional pituitary surgery in patients with Cushings disease, is needed to determine the pros and cons of both techniques.European Journal of Endocrinology 154 675-684

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“…Whereas a shortcoming of endoscopic endonasal pituitary surgery is the loss of binocular vision, microscopic techniques typically result in more sinonasal dissection and potentially more sinonasal morbidity postoperatively. Notwithstanding short-term data suggest that outcomes and complication rates of MIPS compare well to traditional transnasal transsphenoidal approaches, with reduced need for packing, 4 shorter operative times, [5][6][7] decreased blood loss, 8 improved differentiation between normal tissue and tumor, 9 better visualization of intrasellar and parasellar structures, and shorter hospital stays. 1,4,10 While these factors have been thought to translate into improved patient satisfaction and comfort, few studies have examined patient perceptions before and after MIPS.…”

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confidence: 98%

Sinonasal quality‐of‐life before and after endoscopic, endonasal, minimally invasive pituitary surgery

Suberman

Zanation

Ewend

et al. 2011

Int Forum Allergy Rhinol

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Assessment of the Efficacy of Endoscopy in Pituitary Adenoma Resection

Cited by 53 publications

References 28 publications

Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients

Transsphenoidal pituitary surgery via the endoscopic technique: results in 35 consecutive patients with Cushing’s disease

Sinonasal quality‐of‐life before and after endoscopic, endonasal, minimally invasive pituitary surgery

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