Complications in Endoscopic Pituitary Surgery

Vignolles-Jeong, Joshua; Kreatsoulas, Daniel; Godil, Saniya S.; Otto, Bradley A.; Carrau, Ricardo L.; Prevedello, Daniel M.

doi:10.1016/j.otc.2021.12.011

Cited by 9 publications

(6 citation statements)

References 72 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, endocrinopathies following a hemispherectomy aren't common or at least not well documented compared to other brain surgeries such as transsphenoidal hypophysectomy, which postoperatively can be complicated by hypopituitarism or diabetes insipidus [9][10][11]. However, due to the nature of a hemispherectomy procedure, there could be a possibility of affecting structures or pathways related to the endocrine system such as the hypothalamus or pituitary gland [12,13]. Studies have shown that the postoperative course of children following brain surgeries is commonly complicated by hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

Endocrinopathies in a Pediatric Patient Post-anatomical Hemispherectomy for Rasmussen’s Encephalitis Treatment: A Case Report

Sanchez,

Belmar,

Sanchez

et al. 2024

Cureus

View full text Add to dashboard Cite

Hemispherectomy is a neurosurgical procedure that is frequently performed in pediatric patients diagnosed with Rasmussen's encephalitis. Postoperative complications include immediate complications such as hydrocephalus and hemorrhage and behavioral complications such as language impairments and contralateral weakness. However, there are limited studies or case reports that address the potential endocrinopathies associated with this and other pediatric epileptic surgeries. This case report describes the endocrinopathies following an anatomical hemispherectomy procedure. A four-year-old African-American female had a right anatomical hemispherectomy for the treatment of Rasmussen's encephalitis in 2020. The postoperative course was immediately complicated by central diabetes insipidus which was stabilized with desmopressin. The patient’s labs in 2021 were consistent with central precocious puberty with elevated luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Additionally, the patient was found to have secondary adrenal insufficiency in which she failed a low-dose adrenocorticotropic hormone (ACTH) stimulation test. Oral hydrocortisone therapy was initiated for secondary adrenal insufficiency in addition to initiating leuprolide injections for central precocious puberty. Furthermore, at the age of seven years, the patient had her first menarche. This case report emphasizes the need for closer and long-term surveillance for endocrine issues in postepileptic surgical pediatric patients as well as a surveillance plan for the development of other potential endocrine abnormalities throughout the patient’s life.

show abstract

Section: Discussionmentioning

confidence: 99%

Endocrinopathies in a Pediatric Patient Post-anatomical Hemispherectomy for Rasmussen’s Encephalitis Treatment: A Case Report

Sanchez,

Belmar,

Sanchez

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…Xin Qu et al also proposed that a pseudocapsule-based extracapsular resection method could improve postoperative outcomes and maintain normal pituitary function [ 46 ]. Excessive excision during surgery or thermal damage due to bipolar coagulation in the saddle cavity can lead to anterior lobe dysfunction [ 47 ]. Postoperative sellar hematoma is a risk factor for new endocrine dysfunction, and timely removal of hematoma can be partially alleviated [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

et al. 2023

View full text Add to dashboard Cite

Purpose Currently, endoscopic transsphenoidal surgery is the main treatment for pituitary neuroendocrine tumors (PitNETs). Excision of the tumor may have positive or negative effects on pituitary endocrine function, and the pituitary function of somatotroph tumors is a point of particular concern after the operation. This study aimed to conduct a meta-analysis on the effect of endoscopic transsphenoidal somatotroph tumor resection on pituitary function. Methods A systematic literature search was conducted for articles that included the evaluation of pituitary target gland before and after endoscopic transsphenoidal pituitary tumor resection and were published between 1992 and 2022 in PubMed, Cochrane, and Ovid MEDLINE. Results Sixty-eight studies that included biochemical remission rates in 4524 somatotroph tumors were concluded. According to the 2000 consensus, the biochemical remission rate after transsphenoidal endoscopic surgery was 66.4% (95% CI, 0.622–0.703; P = 0.000), the biochemical remission rate was 56.2% according to the 2010 consensus (95% CI, 0.503–0.620; P = 0.041), and with the rate of biochemical remission ranging from 30.0 to 91.7% with investigator’s definition. After endoscopic resection, adrenal axis dysfunction was slightly higher than that before surgery, but the difference was not statistically significant. Hypothyroidism was 0.712 times higher risk than that before surgery (OR = 0.712; 95% CI, 0.527–0.961; P = 0.027). Hypogonadism was 0.541 times higher risk than that before surgery (OR = 0.541; 95% CI, 0.393–0.746; P = 0.000). Hyperprolactinemia was 0.131 times higher risk than that before surgery (OR = 0.131; 95% CI, 0.022–0.783; P = 0.026). The incidence of pituitary insufficiency was 1.344 times the risk before surgery after endoscopic resection of somatotroph tumors, but the difference was not statistically significant. Conclusions In patients with somatotroph tumors after undergoing endoscopic surgery, the risk of dysfunction and pituitary insufficiency tend to increase, while preoperative thyroid insufficiency, gonadal insufficiency, and hyperprolactinemia will be partially relieved.

show abstract

“…Experienced neurosurgeons can better distinguish between tumor pseudocapsule and normal pituitary/stalk during surgery, which is bene cial to protecting endocrine function [42,43]. Excessive excision during surgery or thermal damage due to bipolar coagulation in the saddle cavity can lead to anterior lobe dysfunction [44]. Postoperative sellar hematoma is a risk factor for new endocrine dysfunction and timely removal of hematoma can be partially alleviated [45].…”

Section: Discussionmentioning

confidence: 99%

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

Nie

Fang

Wong

et al. 2022

Preprint

View full text Add to dashboard Cite

Purpose： Currently, endoscopic transsphenoidal surgery is the main treatment for pituitary neuroendocrine tumors (PitNets). Excision of the tumor may have positive or negative effects on pituitary endocrine function and the pituitary function of somatotroph tumors is a point of particular concern after the operation. This study aimed to conduct a meta-analysis on the effect of endoscopic transsphenoidal somatotroph tumor resection on pituitary function. Methods： A systematic literature search was conducted for articles that included the evaluation of pituitary target gland before and after endoscopic transsphenoidal pituitary adenoma resection and published between 1992 and 2022 in PubMed, Cochrane, and Ovid MEDLINE. Results： 68 studies that included biochemical remission rates in 4524 somatotroph tumors were concluded. According to the 2000 consensus, the biochemical remission rate after transsphenoidal endoscopic surgery was 66.4% (95%CI,0.622-0.703; P = 0.000), the biochemical remission rate was 56.2% according to the 2010 consensus (95%CI,0.503-0.620; P = 0.041), and with the rate of biochemical remission ranging from 30.0% to 91.7% with investigator's definition. After endoscopic resection, adrenal axis dysfunction was slightly higher than that before surgery, but the difference was not statistically significant. Hypothyroidism was 0.712 times higher risk than that before surgery（OR=0.712; 95%CI, 0.527-0.961; P=0.027). Hypogonadism was 0.541 times higher risk than that before surgery (OR=0.541; 95%CI,0.393-0.746; P = 0.000). Hyperprolactinemia was 0.131 times higher risk than that before surgery (OR=0.131; 95%CI,0.022-0.783; P = 0.026). The incidence of pituitary insufficiency was 1.344 times risk before surgery after endoscopic resection of somatotroph tumors, but the difference was not statistically significant. Conclusions： Although the biochemical response rate of patients with transsphenoidal endoscopic growth hormone tumor resection will be increased as endoscopic surgery matures, some patients still require postoperative treatment, including gamma-ray therapy or drug take-in. Long-term follow-up and drug replacement therapy are required for newly diagnosed pituitary dysfunction, while the existing preoperative hypophysis can be ameliorated to some extent.

show abstract

Complications in Endoscopic Pituitary Surgery

Cited by 9 publications

References 72 publications

Endocrinopathies in a Pediatric Patient Post-anatomical Hemispherectomy for Rasmussen’s Encephalitis Treatment: A Case Report

Endocrinopathies in a Pediatric Patient Post-anatomical Hemispherectomy for Rasmussen’s Encephalitis Treatment: A Case Report

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

The effect of endoscopic transsphenoidal somatotroph tumors resection on pituitary hormones: systematic review and meta-analysis

Contact Info

Product

Resources

About