Complications of Transsphenoidal Surgery: Results of a National Survey, Review of the Literature, and Personal Experience

Cirić, Ivan; Ragin, Ann B.; Baumgartner, Craig; Pierce, Debi

doi:10.1097/00006123-199702000-00001

Cited by 962 publications

(718 citation statements)

References 60 publications

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“…Pituitary adenomas originate under the sellar diaphragm and thus out of the arachnoid membrane and subarachnoid space 6 . This allows the resection of many tumors without the risk of disrupting the arachnoid 4 .…”

Section: Discussionmentioning

confidence: 99%

“…This allows the resection of many tumors without the risk of disrupting the arachnoid 4 . Postoperative CSF fistula rates after microscopic or endoscopic transsphenoidal methods range between 0.5 to 15% 4,6 . Therefore, the rate of 8.2% of CSF fistula from the present study is documented in these reports.…”

Section: Discussionmentioning

confidence: 99%

“…The decision to use the microscope or the endoscope or both, is primarily based on the surgeon's experience and preference 7 . In 1997 Ciric et al 6 presented data in which 958 North American neurosurgeons reported the complications of transsphenoidal surgery, through a questionnaire. When he subdivided the number of surgeries performed: <200, 200-500, >500, the following postoperative CSF fistula index was found, 4.2%, 2.8% and 1.5% 6 respectively.…”

Section: Discussionmentioning

confidence: 99%

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Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center

Romero

Nora

Topczewski

et al. 2010

Arq. Neuro-Psiquiatr.

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background: Postoperative cerebrospinal fluid (CSF) fistula is the most serious complication after transsphenoidal surgery. Objective: To analyze the incidence of CSF fistula after endoscopic transsphenoidal surgery for tumor removal in sellar region; to discuss associated factors and methods used for sellar closure. Method: Retrospective study of 67 patients (73 surgeries) operated via transsphenoidal endoscopy at Hospital Vall D'Hebron and Hospital Clinic of the Universidad de Barcelona, Spain. The data collected included: age, sex, hospitalization stay, suprasellar extension of the lesion, type of tumor, evidence of intraoperative CSF fistula, complications of postoperative CSF fistula, previous surgery and radiotherapy. results: Six patients (8.2%) had postoperative CSF fistula, and their average hospitalization was 5 days longer with resulting complications: two of whom had pneumoencephalus and two with meningitis. No association was found between the data collected and postoperative CSF fistula. conclusion: The rate of CSF fistula after endoscopic transsphenoidal surgery from the present study is contained within the literature. Unlike other reports, no association between the variables and postoperative CSF fistula was found in this report. Key words: cerebrospinal rhinorrhea, endoscopy, pituitary neoplasms.Fístula liquórica após cirurgia transesfenoidal endoscópica: experiência de um centro espanhol resuMO A fístula liquórica pós-operatória é a complicação mais séria após cirurgia transesfenoidal. Objetivo: Analisar a incidência de fístula liquórica após cirurgia endoscópica transesfenoidal para remoção de tumores selares, discutir fatores associados e método utilizado para fechamento selar. Método: Estudo retrospectivo de 67 pacientes (73 cirurgias) operados via endoscopia transesfenoidal no Hospital Vall D'Hebron e Hospital Clínic da Universidad de Barcelona, Espanha. Os dados coletados foram: idade, sexo, dias de internação, extensão supra-selar da lesão, tipo de tumor, evidência de fístula liquórica intra-operatória, complicações da fístula liquórica pós-operatória, cirurgia e radioterapia prévias. resultados: Seis pacientes (8.2%) tiveram fístula liquórica pós-operatória. Nestes a média de internação hospitalar foi 5 dias maior e tendo complicações decorrentes: dois com pneumoencéfalo e dois com meningite. Não se encontrou associação entre os dados coletados e fístula liquórica pós-operatória. conclusão: A taxa de fistula liquórica após cirurgia transesfenoidal endoscópica do presente estudo está dentro da literatura. Ao contrário de outros relatos, nesta pesquisa não foi encontrada associação entre as variáveis e fístula liquórica pós-operatória. Palavras-chave: endoscopia, neoplasias hipofisárias, rinorreia de líquido cefalorraquidiano.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center

Romero

Nora

Topczewski

et al. 2010

Arq. Neuro-Psiquiatr.

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“…ICA injury during transsphenoidal surgery is reported to most frequently occur during dural incision of the sella floor. 1,4,9) The inner margin of the cavernous sinus and location of the ICA must be confirmed using the navigation system together with the micro-Doppler probe before dural incision. The clivus is observed just beneath the sella turcica and between the Neuroendoscopic Skull Base Surgery ICA eminences (Fig.…”

Section: Approach To Sellar and Clival Lesionsmentioning

confidence: 99%

Neuroendoscopic Transnasal Surgery for Skull Base Tumors: Basic Approaches, Avoidance of Pitfalls, and Recent Innovations

Shin

Kondo

Saito

2012

Neurol. Med. Chir.(Tokyo)

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Since the introduction of endoscopic technology in the neurosurgical field, the role of transnasal surgery has been dramatically enlarged. With this technique, we can approach the anterior cranial base, parasellar region, clivus, cavernous sinus, and craniovertebral junction, less invasively than with conventional microsurgery. This review describes the two major approach methods in endoscopic skull base surgery, the endonasal approach and the transseptal approach. The endonasal approach uses two nostrils without nasal specula and the mucosa on the sphenoid rostrum and the posterior margin of the nasal septum are removed. In the transseptal approach, only a single nostril is available, but using the nasal speculum, sufficient surgical field can be obtained with only a small incision on the septum. In either approach method, it is very important to avoid excessive mucosal damage and to select the appropriate approach for each patient. The endoscopic skull base approach is one of the least invasive surgical procedures, which is a very promising therapeutic choice with potential for further advances. For better surgical outcomes and further progress, cooperation with rhinolaryngologists who have much more knowledge and experience about nasal surgery than neurosurgeons is essential. We believe this article will contribute to the development of safe and effective surgical procedures, and to the benefit of the patients suffering with intractable skull base lesions.

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“…Nei pazienti con DI post-traumatico, può comparire a distanza di un mese dall'evento anche un ipopituitarismo parziale o totale, per ridotta riserva dell'ipofisi anteriore, spesso non associato a segni e sintomi clinici [3].…”

Section: Introductionunclassified

The internal medicine specialist and neurosurgery

Pizzini¹,

Silingardi²,

Iori³

et al. 2013

Ital J Med

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IntroduzionePer le criticità legate alla sede dell'intervento e alla gravità delle complicanze correlate, la neurochirurgia presenta problematiche di particolare impegno per il consulente internista. In ambito neurochirurgico, infatti, si possono manifestare problemi medici con sequele neurologiche anche fatali. I problemi con cui l'internista si trova più frequentemente a confrontarsi, riguardano principalmente la gestione del bilancio idroelettrolitico e il controllo glicometabolico, oltre alle complicanze trombotico-emorragiche e alle infezioni (Tab. 1).In questa revisione si discutono le problematiche endocrinologiche, vascolari, infettivologiche e generali. Per gli aspetti correlati alle alterazioni elettrolitiche (ipo-ipernatriemie) si rimanda alle recenti esaustive revisioni di Sgambato et al. Controllo endocrinologicoIn neurochirurgia sono frequenti le sequele endocrinologiche sia per interventi diretti sulla regione ipotalamo-ipofisaria (per esempio, asportazione di adenomi, lesioni del peduncolo ipofisario) sia per ischemia-emorragia delle connessioni vascolari ipotalamo-ipofisarie (circolo portale).Il diabete insipido (DI) è una comune complicanza di lesioni ipotalamo-ipofisarie, ma può manifestarsi anche in corso di altre patologie cerebrali, quali traumi, meningiti batteriche, intossicazione da alcol, ipertensione endocranica o morte cerebrale, e in seguito all'uso di fenitoina. In particolare, dopo la chirurgia ipofisaria vi è un'aumentata incidenza di sviluppo di DI, che può essere transitorio o Summary BACKGROUND The neurosurgical patient is often a real challenge for the physicians, because of a frequent multimorbidity and a higher risk for severe complications. Cooperation between internal medicine specialist and neurosurgeon is essential to prevent the fatal effects of cranial and spinal injuries. The topic issues of medical interest in neurosurgery are the disorders of sodium balance, the glycemic control, the thromboembolic risk, the intracerebral bleeding management and the infective problems. The neurosurgeons could be worried by treating these complications that are mostly of internal medicine interest and that could unfortunately rise the risk of death or irreversible insults. AIM OF THE REVIEW This review summarizes the modality of diagnosis and therapy of the foremost concerns in neurosurgical field. KEY WORDS

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Complications of Transsphenoidal Surgery: Results of a National Survey, Review of the Literature, and Personal Experience

Cited by 962 publications

References 60 publications

Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center

Cerebrospinal fluid fistula after endoscopic transsphenoidal surgery: experience in a spanish center

Neuroendoscopic Transnasal Surgery for Skull Base Tumors: Basic Approaches, Avoidance of Pitfalls, and Recent Innovations

The internal medicine specialist and neurosurgery

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