Cirugía transnasal endoscópica para tumores de hipófisis

Ajler, Pablo; Hem, Santiago; Goldschmidt, Ezequiel; Landriel, Federico; Campero, Alvaro; Yampolsky, Claudio; Carrizo, Antonio

doi:10.4103/2152-7806.104403

Cited by 6 publications

(2 citation statements)

References 21 publications

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“…In our study, sex was identified to be a significant factor in subgroup analysis. Females (82.69%) were prone to develop meningiomas, and females accounted for 40% of NFPMA cases, which was similar to the results reported in previous studies ( 8 , 22 , 23 ). The clinical manifestations of both tumors were similar, mainly showing reduced vision, blurred vision, headache, and dizziness.…”

Section: Discussionsupporting

confidence: 90%

Differentiating between non-functioning pituitary macroadenomas and sellar meningiomas using ADC

Zhang

Zhao

Dong

et al. 2020

Endocrine Connections

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Introduction and aim: It is difficult to distinguish between non-functioning pituitary macroadenomas (NFPMAs) and sellar meningiomas because of their overlapping imaging manifestations on routine magnetic resonance imaging (MRI), especially in cases of meningiomas growing into the saddle. Here, we aimed to differentiate between these two tumors using apparent diffusion coefficient (ADC) values and MRI characteristics. Methods: A total of 60 NFPMA and 52 sellar meningioma cases confirmed by pathological analysis were retrospectively reviewed. All patients were examined via routine MRI and diffusion weighted imaging (DWI) before undergoing surgery. The clinical, MRI characteristics, and max ADC (ADCmax), average ADC (ADCmean), and minimum ADC (ADCmin) values were compared between the two tumors via Chi-square test and two sample t-tests. Receiver operating characteristic (ROC) curve and binary logistic regression analyses were conducted to determine the discrimination ability. Results: The ADCmax, ADCmean, and ADCmin values were significantly higher in NFPMAs compared to sellar meningiomas (p < 0.001 for all). Among ADC values, ADCmax demonstrated good performance with an AUC of 0.896 (95% CI, 0.823-0.969) and accuracy of 88.7%. A cut-off value of 0.97 × 10−3 mm2/s was used for ADCmax for differentiation between tumors. A combination of ADCmax values and clinicoradiological features showed the best discrimination ability for differential diagnosis between the two tumors, with an AUC of 0.981 (95% CI, 0.958-1.000) and accuracy of 96.9%. Conclusion: A combination of ADCmax and clinicoradiological features demonstrates good discrimination ability and high accuracy for differentiation between NFPMAs and sellar meningiomas, and is a potential quantitative tool to aid in the selection of surgical techniques.

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Section: Discussionsupporting

confidence: 90%

Differentiating between non-functioning pituitary macroadenomas and sellar meningiomas using ADC

Zhang

Zhao

Dong

et al. 2020

Endocrine Connections

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“…The opening of the sellar floor and the resection of the tumor is performed in the sellar phase. It is a challenging procedure due to the complexity of the anatomical region and the limited surgical area [1,5]. Common complications include intercavernous sinus bleeding and internal carotid artery (ICA) laceration [6,9,13].…”

Section: Introductionmentioning

confidence: 99%

Safety window for the transsphenoidal approach for pituitary tumours: a computed tomographic angiography study

et al. 2023

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Critical analysis of anatomical landmarks within the sphenoid sinus for transsphenoidal surgery

Ahmadipour

Lemonas

Maslehaty

et al. 2016

Eur Arch Otorhinolaryngol

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The transsphenoidal approach to the sellar region has been introduced more than a 100 years ago. It is the accepted standard operative corridor to pathologies of the pituitary gland and surrounding structures. There are anatomical landmarks within the sphenoid sinus that are used for orientation directing to the sella floor or the cavernous sinus. Yet, little data can be found on the consistency of these landmarks. It is the aim of this study to evaluate the reliability of these anatomical landmarks for the surgeon's orientation. A total of 245 computed tomography (CT) volume data sets of the cranium performed according to a standardized protocol were analyzed for study purposes. CT scans of the cranium of 125 patients admitted to the emergency room of our hospital receiving a trauma spiral according to the local protocol were employed as a control group when no pathology in the sellar region was observed. In addition, preoperative CT scans of a group of 120 patients diagnosed with pituitary adenomas between 2009 and 2013 were analyzed. Image analysis of the anatomical landmarks included the minimal intercarotid distance (ICD), diameter of the sphenoid sinus (DSS), direction of the septum sinuum sphenoidalium (SSS), and the distance between vomer and clivus (VCD). The overall mean ICD was 16.2 mm, with patients suffering from adenomas showing a mean ICD of 15.8 mm compared with an average 16.5 mm in the control group. DSS was equal for both groups (adenoma group: mean 31.5 mm; controls: mean 31.3 mm). Mean VCD was 27.9 mm in patients with pituitary adenomas compared with 26.7 mm in controls. A septum of the sphenoid sinus located in the midline was found in overall 23 % only. SSS was directed into the bony shield of the internal carotid artery in 28 % of underlying tumors and in 37 % of the control group. This is the first detailed description of landmarks of the sphenoid sinus based on a large radiologic-anatomical analysis of CT scans yielding a wide variation and high inconsistency of these landmarks. From out data, we suggest that the surgeon approaching the sphenoid sinus should handle the anatomical landmarks with care bearing their inconsistency in mind. A thorough planning of the procedure up front is highly recommended. Usage of a navigation system considering the bony structures might as well facilitate as steady the approach to the sellar region in some cases for the patient's sake.

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Cirugía transnasal endoscópica para tumores de hipófisis

Cited by 6 publications

References 21 publications

Differentiating between non-functioning pituitary macroadenomas and sellar meningiomas using ADC

Differentiating between non-functioning pituitary macroadenomas and sellar meningiomas using ADC

Safety window for the transsphenoidal approach for pituitary tumours: a computed tomographic angiography study

Critical analysis of anatomical landmarks within the sphenoid sinus for transsphenoidal surgery

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